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...
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
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.
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.
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.
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...
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...
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.
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.
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.
A confluence of events signals HHS will launch its anticipated healthcare reform law education and outreach campaign next week.
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.
Legislation to muzzle Medicare auditors has received the biggest hospital lobbying push this year—so far, to little effect.
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.
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.
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.
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.
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.
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.
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.