Recovery Audit Contractors

RAC groups battle provider plea for short-stay payment relief

RAC groups battle provider plea for short-stay payment relief

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Third-party firms that audit Medicare bills for payment issues are pushing back hard against a hospital association plea for more favorable short-stay reimbursements, adding to the ongoing unwelcome specter of audits among all providers, including those in long-term care.

Government asks for suggestions on how to reduce Medicare appeals backlog

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The federal government is asking the public to suggest ways of reducing Medicare appeals and cutting down on a backlog at the administrative law judge level. The request for information was filed by the Office of Medicare Hearings and Appeals and published in today's Federal Register.

RACs return $100 million to providers, as criticism grows

RACs return $100 million to providers, as criticism grows

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Medicare Recovery Audit Contractors returned a record $100.4 million in identified underpayments to providers between April and June.

Report: Long-term care providers pay the price for CMS' poor auditor oversight

Report: Long-term care providers pay the price for CMS' poor auditor oversight

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Long-term care and other providers could be facing unfair burdens due to ineffective government oversight of Medicare auditors, according to a new report from a federal watchdog agency.

Long-term care providers would receive more education from auditors under draft Medicare bill

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Medicare auditors would boost outreach and education efforts to long-term care and other providers under the provisions of a draft bill introduced Thursday by Rep. Kevin Brady (R-TX), chairman of the Ways and Means health subcommittee.

Medicare should pay for skilled nursing services without a qualifying hospital stay, experts tell Senators

Medicare should pay for skilled nursing services without a qualifying hospital stay, experts tell Senators

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The time has come to eliminate hospital stay requirements for beneficiaries to qualify for Medicare coverage of skilled nursing services, experts told a Senate committee Wednesday.

RACs returned a record $100 million to providers in the third quarter, CMS announces

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Medicare Recovery Audit Contractors returned $100.4 million in underpayments to healthcare providers in the third quarter of fiscal year 2014, the Centers for Medicare & Medicaid Services has announced.

Senators blast Medicare audits, say RAC payments should be changed

Senators blast Medicare audits, say RAC payments should be changed

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The Medicare claims review process is unfairly burdening healthcare providers and failing to improve program integrity, due in part to the payment system for certain auditors, Senate leaders said during a roundtable hearing Wednesday.

Cash-strapped feds to cut back Medicare oversight this year, OIG official says

Cash-strapped feds to cut back Medicare oversight this year, OIG official says

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One of nursing homes' most vigilant government watchdogs plans to dramatically curb its activities this year, a federal official has told the House Ways & Means Subcommittee on Health. The Department of Health and Human Services Office of the Inspector General anticipates reducing Medicare and Medicaid oversight activities overall by 20% in fiscal year 2014.

RACs were 'most improved' healthcare auditors for getting back money in 2013, government report states

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Medicare Recovery Audit Contractors dramatically stepped up their overpayment recoveries last year, returning nearly $487 million more to the government than they did in 2012, according to a new report from a federal watchdog agency.

RACs recovered $8,000 from skilled nursing facilities, $2.3 billion overall in 2012, report shows

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Medicare recovery audit contractors collected about $8,000 in fiscal year 2012 through a skilled nursing facility claims review pilot, according to a recently released annual report to Congress.

Medicare appeals at the administrative law judge level will be suspended for two years due to backlog, agency announces

Medicare appeals at the administrative law judge level will be suspended for two years due to backlog, agency announces

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Long-term care providers filing to have a Medicare claims appeal heard by an administrative law judge will not have the case assigned to a judge for at least two years, according to the Office of Medicare Hearings and Appeals.

Feds ease auditing reviews, anti-fraud efforts to surge

Feds ease auditing reviews, anti-fraud efforts to surge

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Providers likely will embrace House legislation that eases billing reviews for operators deemed a low fraud risk.

RAC program needs better oversight, Inspector General report finds

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Recovery audit contractors might be better at reviewing Medicare claims than critics allege, but the Centers for Medicare & Medicaid Services could improve RAC performance evaluations, according to a new government report.

Ask the payment expert ... about RAC nursing home audits

Ask the payment expert ... about RAC nursing home audits

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We keep hearing about RACs in skilled nursing homes but we haven't seen any in our state, so why should we worry about them?

Bill calls for faster action on RAC reports, more 'expert' Medicaid oversight

Bill calls for faster action on RAC reports, more 'expert' Medicaid oversight

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The Centers for Medicare & Medicaid Services should move faster to make changes based on Medicare audits and should have more direct oversight over Medicaid, according to bipartisan legislation introduced Tuesday. "The Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2013" proposes a variety of reforms to cut down on waste, fraud and abuse. The PRIME Act was introduced by Sens. Tom Carper (D-DE) and Tom Coburn (R-OK), and Reps. John Carney (D-DE) and Peter Roskam (R-IL).

RACs push back against audit improvement bills

RACs push back against audit improvement bills

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An advocacy group for independent Medicare auditors has sharply criticized two bills that would put new controls on Recovery Audit Contractors. The Medicare Audit Improvement Act of 2013 was introduced in the House of Representatives in March. A Senate version of the bill was introduced last month. The bill would rein in auditors and improve transparency, which have been provider concerns.

RAC transition: Fewer document requests but no slowing of therapy reviews, CMS says

RAC transition: Fewer document requests but no slowing of therapy reviews, CMS says

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Providers will see fewer Additional Document Requests starting in June, as the Centers for Medicare & Medicaid Services transitions to new Recovery Audit Program contracts. CMS has started the contract procurement process by issuing a request for quotes through the General Services Administration, according to a Medicare newsletter released Thursday.

CMS explains therapy cap notification requirement, but more guidance needed, NASL leader says

CMS explains therapy cap notification requirement, but more guidance needed, NASL leader says

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A recent Centers for Medicare & Medicaid memorandum provides some clarity regarding new therapy cap notification rules, but providers still need guidance on other aspects of therapy reimbursement, according to Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care.

CMS announces lower minimum request limit for recovery audit contractors

CMS announces lower minimum request limit for recovery audit contractors

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Medicare recovery audit contractors (RACs) can request as few as 20 records in a 45-day period from skilled nursing facilities and other providers as of April 15, according to the Centers for Medicare & Medicaid Services. This is a reduction from the current 35-record minimum request.

AHCA opposes manual review system for therapy claims, launches provider feedback clearinghouse

AHCA opposes manual review system for therapy claims, launches provider feedback clearinghouse

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As part of its pushback against the manual review process for therapy claims, the American Health Care Association has launched a clearinghouse to gather provider feedback. AHCA President Mark Parkinson described the RAC-led review process as "bifurcated, confusing and wholly inappropriate" in a four-page letter sent to Acting CMS Administrator Marilyn Tavenner last week.

TODAY'S THE DAY: McKnight's Online Expo kicks off with session on MDS 3.0 as lawmakers reintroduce audit bill

TODAY'S THE DAY: McKnight's Online Expo kicks off with session on MDS 3.0 as lawmakers reintroduce audit bill

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Representatives Sam Graves (R-MO) and Adam Schiff (D-CA) recently reintroduced a bill to ease audit burdens on long-term care providers. Initially put forward in Oct. 2012, the Medicare Audit Improvement Act would change the way Medicare recovery audit contractors (RACs) operate.

Laws and policies in focus next week for LTC therapy and ancillary services providers

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A keynote address by Farzad Mostashari, MD, ScM, the National Coordinator for Health Information Technology, will highlight opening day of the annual winter Legislative and Regulatory Conference of the National Association for the Support of Long-Term Care.

OIG: Medicare contractors, antipsychotics in SNFs to get a closer look

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The Medicare contractors keeping close tabs on long-term care facilities will be subject to oversight too, according to a federal working plan released this week.

Medicare auditors becoming more active, denying more claims, survey shows

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Requests for medical records by Medicare's fraud-detecting recovery audit contractors (RACs) jumped sharply from the first- to the second-quarter of fiscal year 2012, a new survey reveals.

Lawmakers blast federal efforts to monitor and police Medicare fraud -- again

Lawmakers blast federal efforts to monitor and police Medicare fraud -- again

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Lawmakers again hammered the Centers for Medicare & Medicaid Services' Medicare program integrity contractors Friday. The latest salvos were fueled by an agency admission that additional mistakes had been made.

OIG: Regulators need to sharpen retrieval of Medicare overpayments made to providers

OIG: Regulators need to sharpen retrieval of Medicare overpayments made to providers

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Medicare recovery audit contractors have not been diligent enough in collecting previously identified overpayments, a government investigation finds.

Low-quality Medicare Advantage plans should expect scrutiny, CMS says

Low-quality Medicare Advantage plans should expect scrutiny, CMS says

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Medicare Advantage plans with fewer than five stars on the quality scale should expect some form of audit, a Centers for Medicare & Medicaid official said this week.

Report: Improper Medicare Advantage payments fell $1.2 billion in 2011

Report: Improper Medicare Advantage payments fell $1.2 billion in 2011

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Recovery audit contractors and other quality assurance efforts allowed Medicare Advantage to reduce improper payments by $1.2 billion in 2011, according to a new government report.

More collaboration between Medicare and Medicaid fraud detection programs is needed, report finds

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More communication is needed between Medicare and Medicaid's respective program integrity officials, a new report suggests.