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Comments on RAC stats refreshing

October 02, 2014

Regarding “RACs' effectiveness exaggerated”: It is refreshing to see this rebuttal, calling CMS statistics out when they are so far from accurate.

RACs' effectiveness exaggerated

October 01, 2014

Regarding “RACs recouped $3B for Medicare in 2013”: I am a healthcare statistician who works very closely with pre- and post-audit compliance risk and mitigation issues. I would strongly disagree with the validity of the 18.1% reversal rate claimed by the recovery audit contractor trade...

RACs recouped $3B for Medicare in 2013

By Bob Herman  |  September 29, 2014

Medicare's recovery auditors returned more than $3 billion into the program's coffers last year, a new government report shows. And providers that appealed those audits won less than 1 in 5 tries. While the RAC trade group cheered the report, it isn't quelling provider criticism of the RAC program.

Some providers already taking Medicare's RAC appeal deal

Some providers already taking Medicare's RAC appeal deal

By Bob Herman  |  September 11, 2014

It's been about two weeks since the CMS told hospitals and health systems it would pay a portion of appealed inpatient-status claims, and at least a few have taken Medicare up on its offer.

CMS offers deal in lieu of RAC appeal

CMS offers deal in lieu of RAC appeal

By Bob Herman  |  September 06, 2014

The CMS has made a tempting offer to hospitals as a way to clear its heavily backlogged Medicare appeals process, and many may take it to save time and money.

Medicare needs to end observation status for patients

Medicare needs to end observation status for patients

By Dr. Chris Edwards  |  September 06, 2014

Every time I see a story about the issue of observation services I feel compelled to reply. Quite frankly, it is the existence of observation services that is actually the problem. Any solution has to include the elimination of observation.

CMS offers holiday sale on audit appeals

CMS offers holiday sale on audit appeals

By Modern Healthcare  |  August 30, 2014

In a pre-Labor Day weekend bid to lower its backlog of contentious payment disputes, the CMS late Friday offered to pay hospitals 68% of all medical claims appealed by the service providers after having been rejected by outside auditors.

Hospitals hope for relief from CMS' two-midnight rule

Hospitals hope for relief from CMS' two-midnight rule

By Bob Herman  |  August 23, 2014

Lots of people have ideas about how to change Medicare's unpopular two-midnight rule for short patient stays. But based on the public comments the CMS solicited in May, there's no consensus on what a new policy should look like.

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