Recovery Audit Contractor (RAC) news and information

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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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.
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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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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.
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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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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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Read an edited excerpt of the transcript for Modern Healthcare's Dec. 18 editorial webcast, “Avoiding the RAC Trap,” hosted by Modern Healthcare reporter Joe Carlson.
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A little-noticed provision in the fiscal-cliff package will give Medicare officials more time to take back an estimated $500 million in payments made to hospitals and physicians.
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The GAO says the CMS could potentially save tens of millions of dollars a year by standardizing how Medicare payments to hospitals and physicians are audited before the bills are paid.
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The scrutiny of payments to hospitals has never been more intense. And as the federal government expands efforts to collect Medicare and Medicaid overpayments, healthcare providers see a growing need for strategies to proactively ensure that they are being paid accurately under those programs.
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