Tag : feature

FROM FIERCE HEALTHCARE: The Centers for Medicare & Medicaid Services will revise its Recovery Audit Contractors (RAC) program to sharpen agency oversight, reduce the burden on providers and increase transparency. Under the new plan, CMS will restrict the RAC program’s window for patient status reviews to six months if the provider submits its claim within three months of the date of service. The changes will be effective with each new contract awarded under the program, beginning with the contract for RAC Region 5 […]

FROM HEALTHCARE DIVE: Dive Brief: The Centers for Medicare and Medicaid Services in December announced that it has extended its contracts with the four private companies that manage the organization’s recovery audit program. The four companies are CGI Federal, Connolly, HealthDataInsights and Performant Recovery. The contracts were originally slated to end in February of last year, but were extended to December 31. Under the new extension, the companies will be responsible for identifying and ameliorating improper Medicare payments until December 31, […]

FROM MCKNIGHT’S: Connolly LLC will be the recovery audit contractor responsible for reviewing durable medical equipment, hospice and home health claims on a nationwide basis, the Centers for Medicare & Medicaid Services recently announced. This kicks off the new round of RAC contracts, and promised changes to the program now will start to be implemented, CMS stated. RAC activity has been severely curtailed since February 2014, as the last round of contracts came to an end. Healthcare providers, including long-term care providers, […]

FROM INSIDE HEALTH POLICY: The federal DC District Court dismissed the American Hospital Association’s lawsuit to compel HHS to turn around Medicare appeals decisions on time — within 90 days at the third level of appeals — and ruled that Congress and HHS should solve the problem, not the courts. The AHA said it plans to appeal the dismissal. US District Court Judge James Boasberg said he sympathizes with the hospitals but it’s not his place to intervene. “In the […]

FROM MODERN HEALTHCARE: A U.S. District Court judge has dismissed a lawsuit by hospitals seeking to compel HHS to meet statutory timelines for processing appeals to recovery audits. The American Hospital Association said in a statement that it disagrees with the court’s decision and expects to file an appeal. “While the court itself recognizes that hospitals simply cannot afford to have billions of dollars that are needed for patient care tied up indefinitely in the appeals process, its decision means […]

FROM INSIDE CMS: Lawmakers in their report accompanying the recently passed fiscal 2015 spending bill blast CMS’ Recovery Audit contractor program for harming providers and contributing to the backlog at the third level of Medicare appeals. But the American Coalition for Healthcare Claims Integrity, which represents RACs, slammed appropriators for being sympathetic to providers, who the RACs allege are incorrectly billing Medicare, and say the report amounts to the hospital industry using lawmakers to bully CMS over the RAC program. […]

Despite efforts to combat waste and abuse of taxpayer funds, providers use members of Congress to keep Medicare money coming. FROM THE WALL STREET JOURNAL: When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened. Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official who oversees Medicare, Marilyn Tavenner, asking her to back down, according to documents reviewed by […]