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Tag : RAC

Low Volume Medicare Providers Get “Free Pass” From Auditing

Washington, D.C. – The Centers for Medicare & Medicaid Services (CMS) implemented new additional document request (ADR) limits last year that restrict Medicare recovery auditors to review no more than 0.5 percent of a provider’s total number of Medicare claims. The new ADR policy renders 99.5 percent of Medicare claims off limits from review for billing accuracy and has produced another side effect – low volume providers are now mathematically exempt from audits entirely. For example, any Medicare provider that […]

Viewpoint: Some providers receive a ‘free pass’ from auditing Medicare claims

Low-volume Medicare providers escape from having claims reviewed for accuracy under new additional documentation request limits for recovery audits, according to Kristin Walter, an opinion contributor to The Hill. Ms. Walter, spokesperson for The Council for Medicare Integrity, outlines the new policy and her viewpoint in a recent article. CMS in May 2016 revealed new ADR limits for the Medicare Fee-For-Service Recovery Audit Program. The policy calls for an annual baseline ADR limit of 0.5 percent of the provider’s paid Medicare claims from […]

No, RAC audits do not impact patient care

Many myths are tough to dispel because they are so often repeated. No, cold weather does not give you the cold or flu. A shark cannot smell a single drop of blood from miles away. Chewing gum does not stay in your stomach for seven years. And, be careful because lightning can, in fact, strike the same place twice. Despite being thoroughly debunked; some still believe myths like these are true. The same goes for myths about Medicare Recovery Audit […]

Advocacy Group Urges HHS Secretary to Prioritize Reduction of Medicare Improper Payments

Washington, D.C. – Today, The Council for Medicare Integrity (CMI) sent a letter to Department of Health & Human Services (HHS) Secretary Tom Price asking for expanded efforts to reduce improper payments within the Medicare program. Last week, the Secretary testified before the Senate Finance Committee stating, “we are absolutely committed to program integrity.” The letter urges the Secretary to bolster program integrity efforts that protect Medicare resources and discusses concerns for the financial future of the Medicare program. “With Medicare […]

CMI Urges Congress to Mandate Medicare RAC Pre-Pay Claim Reviews

Leveraging expertise of recovery auditors could prevent billions lost to improper billing Washington, D.C. – Today, the Council for Medicare Integrity (CMI) asked Members of Congress to champion the authorization of a prepayment Recovery Audit Contractor (RAC) Program to review Medicare Fee-For-Service (FFS) claims before they are paid to identify errors and prevent tens of billions in improper payments from draining from the program each year. Medicare loses more money to improper payments than any other program government-wide. An improper […]