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‘Oversight Holiday’ Drives RAC Recoveries to Lowest Level In Program History

FOR IMMEDIATE RELEASE March 10, 2015 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com                                                                                                                   (202) 898-0995   ‘Oversight Holiday’ Drives RAC Recoveries to Lowest Level In Program History While GAO Reports Provider Inappropriate Medicare Billing Highest in History Washington, D.C. – The Centers for Medicare and Medicaid Services (CMS) Medicare Fee-for-Service National Recovery Audit Program report for the first quarter of 2015 shows Recovery Audit Contractors (RACs) recovered $48.25 million in misused Medicare funds between October and December 2014, the lowest rate of […]

In Business Madison: Report: State hospitals overbilled Medicare

From In Business Madison: Report: State hospitals overbilled Medicare An annual report from the Center for Medicare and Medicaid Services (CMS) shows Wisconsin hospitals overbilled Medicare by $40 million in 2013, the most recent year for which data is available. That year, the state ranked 27th on a list of the worst states when it comes to Medicare waste. According to a report from the Council for Medicare Integrity, which analyzes CMS data, the rate of improper payments nationwide has […]

Report: Texas Is Sixth Worst State In U.S. For Wasteful Medicare Billing

From D Healthcare Daily, D Magazine: Report: Texas Is Sixth Worst State In U.S. For Wasteful Medicare Billing A federal report has found that Texas was the sixth-worst state in the nation for excess and errant Medicare charges in 2013, a year that saw Lone Star State providers overbill the feds to the tune of $152 million, about $56 million more than they did the year before. The Centers for Medicare and Medicaid Services presented the 2013 Recovery Audit Contracting program […]

McKnight’s: Controversial Medicare auditors group changes name, website

From McKnight’s: Controversial Medicare auditors group changes name, website A Medicare payment watchdog group saddled with huge case backlogs and heavily criticized for causing delays in resolving reimbursement issues has changed its name and location on the web. The Council for Medicare Integrity, formerly the American Coalition for Healthcare Claims Integrity, will continue to support the recovery audit contractor program and will also work with hospitals and physicians to help lower improper payments, the group said in announcing its new […]

Texas Hospitals Overbilled Medicare $152 Million, State Ranks 6th in U.S. for Medicare Waste

FOR IMMEDIATE RELEASE March 2, 2015 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 Texas Hospitals Overbilled Medicare $152 Million, State Ranks 6th in U.S. for Medicare Waste Washington, D.C. – Texas ranks sixth on a national list of the worst states for Medicare waste, overbilling Medicare $152 million in 2013, according to an annual report by the Center for Medicare and Medicaid Services (CMS). Texas held its position at number six in 2013, the most recent year for which government data […]

Forbes: To Cut Spending Waste, Congress Should Restore Medicare RAC Programs

From Forbes.com: To Cut Spending Waste, Congress Should Restore Medicare RAC Programs February 23, 2015 If a corporation discovered it had made thousands of dollars in improper payments, it would, not doubt, undertake every step to stop the wasted money and collect the improper payments. The federal government, however, acts under a different set of rules. During each of the last five years, agencies have doled out more than $100 billion in erroneous payments from various major benefit programs. Improper […]

Bloomberg BNA: What Do RACs Think of Hospitals’ Efforts to Change Short-Stay Policies?

From Bloomberg BNA:  Feb 20, 2015 WHAT DO RACS THINK OF HOSPITALS’ EFFORTS TO CHANGE SHORT-STAY POLICIES? Recovery Audit Contractors (RACs) view attempts by providers to change reimbursement levels for short-term hospital admissions as part “of an ongoing effort on the part of the hospital industry to weaken oversight,” a spokeswoman for the American Coalition for Healthcare Claims Integrity (ACHCI), a trade association for the RACs, told me Feb. 17. The ACHCI comment came in response to a Feb. 13 […]

McKnight’s: RAC Groups Battle Provider Plea for Short-Stay Payment Relief

From McKnight’s: RAC groups battle provider plea for short-stay payment relief Safety commission weighs petitions for total bed-rail ban, seeks input Third-party firms that audit Medicare bills for payment issues are pushing back hard against a hospital association plea for more favorable short-stay reimbursements, adding to the ongoing unwelcome specter of audits among all providers, including those in long-term care. The American Coalition for Healthcare Claims Integrity, which advocates for Recovery Audit Contractors, told one media outlet Tuesday that Medicare […]

Inside Health Policy: Recovery Auditors Blame ‘Frequent Filers’ for ALJ Backlog

From Inside Health Policy: Recovery Auditors Blame ‘Frequent Filers’ For ALJ Backlog Posted: February 18, 2015 Recovery Auditors are again alleging that hospital “frequent filers” are the cause of the backlog at the third level of the appeals system, and point to a coalition analysis that found only a small percentage of RAC denials were appealed to the Administrative Law Judges in recent years. “A backlog of 750,000 cases afflicting the Center for Medicare and Medicaid Service’s (CMS) most effective Medicare integrity program […]

Hospital Industry’s ‘Frequent Filers’ at Root of ALJ Backlog

FOR IMMEDIATE RELEASE February 17, 2015                   CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 Hospital Industry’s ‘Frequent Filers’ at Root of ALJ Backlog Washington, D.C. – A backlog of 750,000 cases afflicting the Center for Medicare and Medicaid Service’s (CMS) most effective Medicare integrity program is due to the volume of provider appeals at the Administrative Law Judge (ALJ) level, not systemic flaws in the Recovery Audit Contractor (RAC) program as hospital groups […]