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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 […]

CCAGW: Taxpayer Watchdogs Urge Members to Protect RAC Program: Program is Highly Effective Anti-Medicare Fraud Tool

From Council for Citizens Against Government Waste: Taxpayer Watchdogs Urge Members to Protect RAC Program: Program is Highly Effective Anti-Medicare Fraud Tool For Immediate Release Contact: Leslie Paige 202-467-5300 February 12, 2015 (Washington, D.C.) – Today, the Council for Citizens Against Government Waste (CCAGW) was joined by five organizations in a letter to members of the House Ways and Means and Senate Finance Committees, urging them to protect the Recovery Audit Program (RAC) from further meddling when Congress considers legislation […]

Fierce Healthcare: CMS revises RAC program to increase transparency, oversight

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 […]

Healthcare Dive: CMS extends contracts with RAC managers

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, […]

McKnight’s: CMS begins new round of recovery audit contracts, says improvements will be seen

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, […]

CMS Awards Recovery Audit DME Contract

FOR IMMEDIATE RELEASE December 31, 2014 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 CMS Awards Recovery Audit DME Contract Spotlight on the area that accounts for highest percentage of the CERT error rate Washington, D.C. – The Centers for Medicare and Medicaid Services (CMS) moved forward to award the first national recovery audit contract to identify Medicare improper payments among Durable Medical Equipment and Home Health and Hospice (DME/HH-H) claims. The contract was awarded to Connolly, LLC, a subsidiary of Connolly iHealth […]