Recovery Audit Contractor (RAC) news and information

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