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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

CMS recovery audits on hold as contractors wrestle big backlog

CMS recovery audits on hold as contractors wrestle big backlog

By Beth Kutscher  |  February 20, 2014

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...

RAC appeals backlog cause for frustration

RAC appeals backlog cause for frustration

By Joe Carlson  |  January 10, 2014

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.

Auditors will delay scrutiny of 'two-midnight' rule: CMS

Auditors will delay scrutiny of 'two-midnight' rule: CMS

By Joe Carlson  |  September 26, 2013

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.

Auditing inpatient stays

Auditing inpatient stays

By Joe Carlson  |  September 07, 2013

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...

Good, but not perfect

By Joe Carlson  |  September 07, 2013

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...

Providers to discuss RAC program with Finance Committee

By Rich Daly  |  June 24, 2013

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.

Admissions conundrum

Admissions conundrum

By Jessica Zigmond  |  June 15, 2013

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.

AHA gathers in D.C. as Congress clears out

AHA gathers in D.C. as Congress clears out

By Jessica Zigmond  |  April 29, 2013

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.

Painful side effects

Painful side effects

By Joe Carlson  |  April 12, 2013

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.

House lawmakers reintroduce RAC reform legislation

By Jessica Zigmond  |  March 19, 2013

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.

Late News: Fight continues

By Joe Carlson  |  March 16, 2013

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.

Hospitals reject new Part B rebilling rule

Hospitals reject new Part B rebilling rule

By Joe Carlson  |  March 14, 2013

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.

In the spotlight

In the spotlight

By Beth Kutscher  |  March 02, 2013

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.

Under the microscope

Under the microscope

By Joe Carlson  |  February 22, 2013

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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