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RAC: Recovery Audit Contractor Program
The Centers for Medicare & Medicaid Services (CMS) has taken the next steps in the agency’s comprehensive efforts to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program by awarding contracts to four permanent Recovery Audit Contractors (RACs) designed to guard the Medicare Trust Fund.
 
Modern Healthcare Coverage of RAC
News
CMS recovery audits on hold as contractors wrestle big backlog
By Beth Kutscher | February 20, 2014 | Basic Web Basic Web Subscription Details
The CMS is winding down its recovery audit program with its current contractors, placing the program effectively on hold—perhaps for several months—while it awards new contracts. The pause could be tacit acknowledgment of the need to address issues with the program, a healthcare analyst...
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News
RAC appeals backlog cause for frustration
By Joe Carlson | January 10, 2014 | Basic Web Basic Web Subscription Details
Appealing bad decisions by Medicare's recovery audit contractors has never been easy. But the system has become so overloaded in recent months that some are calling it an administrative quagmire that is denying basic due process rights because it takes so long.
FULL STORY »
 

Vital Signs
RAC program spurs spike in administrative appeals by hospitals, report says
By Joe Carlson | October 03, 2013
The advent of recovery auditing in Medicare has led to a sharp increase in administrative appeals by hospitals, creating administrative logjams but not necessarily leading to victories for providers complaining about denied payments.
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News
Auditors will delay scrutiny of 'two-midnight' rule: CMS
By Joe Carlson | September 26, 2013 | Basic Web Basic Web Subscription Details
Addressing broad anger about the new “two-midnights” rule for outpatient observation, the CMS announced that recovery auditors will delay scrutiny of short inpatient stays for 90 days.
FULL STORY »
 

Magazine
Auditing inpatient stays | 'Two-midnight' rule may still prove costly
By Joe Carlson | September 07, 2013 | Print Magazine Print Magazine Subscription Details
CMS officials know that Medicare patients spend too much time with the murky status of outpatient observation, which leaves them on the hook for higher out-of-pocket costs. But a rule going into effect Oct. 1 may do little if anything to reverse the trend. Experts warn it may prompt hospitals to...
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Magazine
Good, but not perfect | RAC program detects too little fraud: OIG report
By Joe Carlson | September 07, 2013 | Print Magazine Print Magazine Subscription Details
The hospital industry says Medicare's retrospective program of auditing hospital bills challenges too many claims that later turn out to be justified. But a report by HHS' Office of the Inspector General found that the Medicare recovery audit program is more accurate than hospital lobbyists...
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News
RAC program more accurate than lobbyists say, but isn't perfect, OIG report says
By Joe Carlson | September 04, 2013 | Basic Web Basic Web Subscription Details
Medicare's much-criticized recovery audit program is far more accurate than hospital lobbyists say it is, though it's far from perfect and detects too little fraud rather than too much, according to a new report from HHS' inspector general's office.
FULL STORY »
 

News
OIG wants skilled-nursing access for all Medicare beneficiaries
By Jessica Zigmond | July 30, 2013 | Basic Web Basic Web Subscription Details
HHS' office of the inspector general is urging the CMS to ensure Medicare beneficiaries have the same access to skilled-nursing care after leaving the hospital, regardless of how their stay is coded.
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News
Providers to discuss RAC program with Finance Committee
By Rich Daly | June 24, 2013 | Basic Web Basic Web Subscription Details
Providers upset about what they say are unintended effects of Medicare's RAC program will get a chance to air their grievances today on Capitol Hill and perhaps garner support to change it.
FULL STORY »
 

News
Reform Update: HHS' reform education effort appears near
By Jessica Zigmond | June 21, 2013 | Basic Web Basic Web Subscription Details
A confluence of events signals HHS will launch its anticipated healthcare reform law education and outreach campaign next week.
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Magazine
Admissions conundrum | CMS looks to reduce long observation stays, but hospitals see it as another cut
By Jessica Zigmond | June 15, 2013 | Print Magazine Print Magazine Subscription Details
Federal officials are looking to scale back the use of long observation stays believed to be a response to Medicare auditors cracking down on inappropriate admissions.
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News
RAC bill getting hospital lobby's biggest push
By Rich Daly | May 24, 2013 | Basic Web Basic Web Subscription Details
Legislation to muzzle Medicare auditors has received the biggest hospital lobbying push this year—so far, to little effect.
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News
AHA gathers in D.C. as Congress clears out
By Jessica Zigmond | April 29, 2013 | Basic Web Basic Web Subscription Details
Members of Congress went home just in time for hospital executives to arrive in Washington for the American Hospital Association's annual membership meeting this week.
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Magazine
Painful side effects | Drug-abuse problems evade paltry anti-fraud efforts in Medicare Part D
By Joe Carlson | April 12, 2013 | Print Magazine Print Magazine Subscription Details
Abuse of prescription painkillers causes more fatalities than heroin and cocaine combined. Yet efforts to stop the Medicare fraud that puts drugs on the black market aren't working as they should.
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News
House lawmakers reintroduce RAC reform legislation
By Jessica Zigmond | March 19, 2013 | Basic Web Basic Web Subscription Details
Two House members are again pushing legislation aimed at improving the Recovery Audit Contractor program, which the lawmakers say causes unnecessary costs and bureaucratic headaches for hospitals.
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Magazine
Late News: Fight continues | Despite new rules, AHA sues CMS over billing
By Joe Carlson | March 16, 2013 | Print Magazine Print Magazine Subscription Details
The American Hospital Association is not backing down from its lawsuit against the CMS that claims healthcare providers have lost hundreds of millions of dollars in reimbursements through a billing policy that unfairly penalizes providers who submit incorrect Medicare claims.
FULL STORY »
 

News
Hospitals reject new Part B rebilling rule
By Joe Carlson | March 14, 2013 | Basic Web Basic Web Subscription Details
A sweeping new CMS rule to address hospitals' complaints that they have been denied hundreds of millions of dollars will not lead the American Hospital Association to drop its lawsuit over the issue.
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Magazine
In the spotlight | For-profit hospital chains boost their defenses as regulators step up anti-fraud scrutiny
By Beth Kutscher | March 02, 2013 | Print Magazine Print Magazine Subscription Details
Investor-owned healthcare systems have been adding to their legal ranks and boosting self-policing in an attempt to get one step ahead of heightened regulatory activity around fraud and abuse.
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Magazine
Under the microscope | Intensity of scrutiny by ZPICs draws provider complaints, attention from feds
By Joe Carlson | February 22, 2013 | Print Magazine Print Magazine Subscription Details
The popular notion in healthcare is that the most aggressive fraud hunters—known as “zone program integrity contractors,” or ZPICs—focus on small players. That idea is wrong.
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News
AHA lends support for recovery audit contractor program changes
By Jessica Zigmond | October 16, 2012 | Basic Web Basic Web Subscription Details
The country's hospitals offered their support Tuesday for federal legislation that would make changes to the recovery audit contractors program and other national audit programs.
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Other RAC Resources
 
Reader Exchanges
News
Initial screening could save on audits
October 06, 2011 | Basic Web Basic Web Subscription Details
My question is, how much of the recovery included simple coding mistakes—i.e. duplicate lines etc.—that the financial intermediary could have and should have caught?
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