Revenue Cycle

Revenue Cycle Articles by Topic: Auditing

OIG issues review of Medicare appeals at the Administrative Law Judge level

  • Recovery Auditor Report, Issue 24, November 29, 2012

    On November 15, the OIG issued a review of ALJ appeals decided in fiscal year 2010.

Roundup: Relevant Medicare updates

  • Recovery Auditor Report, Issue 24, November 29, 2012

    CMS issues notice on hospital outpatient payment panel

Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

  • Recovery Auditor Report, Issue 23, November 15, 2012

    On October 16, it was reported that legislation was introduced by Representative Sam Graves (R-MO...

Recent Recovery Auditor Activity

  • Recovery Auditor Report, Issue 23, November 15, 2012

    HealthDataInsights posts four new issues across two categories

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 23, November 14, 2012

    HealthDataInsights posts two new issues for outpatient hospital claims

Recovery Auditor improvements, transparency highlight house legislation bill

  • Recovery Auditor Report, Issue 22, November 1, 2012

    Representative Sam Graves (R-MO) introduced legislation October 16 that aims to improve the...

Recent Recovery Auditor Activity

  • Recovery Auditor Report, Issue 22, November 1, 2012

    Performant Recovery posts three issues across two categories  

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 21, October 18, 2012

    HealthDataInsights posts two new issues across two categories, including first prepayment review...

Recent Recovery Auditor Activity

  • Medicare Update for CAHs, Issue 21, October 17, 2012

    HealthDataInsights posts two new issues across two categories, including first prepayment review...

HCPro's 2012 Medicare Compliance Forum

  • Recovery Auditor Report, Issue 20, October 4, 2012

    HCPro and the Revenue Cycle Institute team are proud to announce the 2012 Medicare Compliance Forum

CMS releases latest Recovery Auditor improper payment figures

  • Recovery Auditor Report, Issue 20, October 4, 2012

    Following the close of each fiscal year (FY) quarter, CMS releases statistics for the amount of...

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 20, October 4, 2012

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 19, September 20, 2012

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 19, September 20, 2012

    DCS Healthcare posts new issue for inpatient hospital claims

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 18, September 6, 2012

    DCS Healthcare posts new issue for outpatient hospital claims

Recovery Auditor prepayment review ODF transcript and audio

  • Recovery Auditor Report, Issue 18, September 6, 2012

    The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...

Double trouble: DRG 312 to be reviewed prepayment and postpayment?

  • Medicare Update for CAHs, Issue 18, September 5, 2012

    Following the announcement of the official start date of prepayment reviews (set to begin August...

Recovery Auditor prepayment review ODF transcript and audio

  • Medicare Update for CAHs, Issue 18, September 5, 2012

    The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...

Recent Recovery Auditor Activity

  • Recovery Auditor Report, Issue 17, August 23, 2012

    Connolly posts 10 new issues across three categories

MCF 2012 audio spotlight: Major news in OPPS proposed rule

  • Medicare Update for CAHs, Issue 17, August 22, 2012

    In the recently released 2013 OPPS proposed rule, CMS issued a request for comments that suggests...

CMS announces official start date for Recovery Auditor prepayment reviews

  • Recovery Auditor Report, Issue 15, August 9, 2012

    CMS officially announced the Recovery Auditor prepayment review demonstration this past November...

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 14, August 9, 2012

    DCS Healthcare posts seven new issues across four categories

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 16, August 8, 2012

    DCS Healthcare posts new issue for DME claims

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 14, July 26, 2012

    CGI posts four new issues for physician claims

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 15, July 25, 2012

    CGI posts four new issues for physician claims

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 13, July 12, 2012

    CGI posts new issue for outpatient claims

Important Medicare updates

  • Medicare Update for CAHs, Issue 14, July 11, 2012

    CMS instructs on provider self audits

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 14, July 11, 2012

    CGI posts new issue for outpatient claims

Coming soon: Recovery auditor prepayment reviews

  • Recovery Auditor Report, Issue 12, June 28, 2012

    Last November, CMS unveiled three demonstration projects aimed at reducing improper payments in the...

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 12, June 28, 2012

    HealthDataInsights posts seven new issues across three categories

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 12, June 27, 2012

    HealthDataInsights posts seven new issues across three categories

CMS publishes improper payment figures and appeals statistics

  • Patient Access Weekly Advisor, Issue 24, June 20, 2012

    In the last month, CMS posted two separate sets of data that provide nationwide statistics on its...

Recent Recovery Auditor Activity

  • Recovery Auditor Report, Issue 11, June 14, 2012

    DCS Healthcare posts ten new issues across six categories

CMS identifies CERT, Recovery Auditor findings in latest quarterly compliance newsletter

  • Recovery Auditor Report, Issue 10, May 31, 2012

    Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.

Note from the instructor: CMS to release new short-term acute care PEPPER

  • Recovery Auditor Report, Issue 10, May 31, 2012

    In late May, CMS plans to release nationwide a new short-term (ST) acute care Program for...

CMS identifies CERT, Recovery Auditor findings in latest quarterly compliance newsletter

  • Medicare Update for CAHs, Issue 11, May 30, 2012

    Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.

CMS identifies CERT, Recovery Auditor findings in latest quarterly compliance newsletter

  • Patient Access Weekly Advisor, Issue 20, May 23, 2012

    Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter...

Recent OIG reports show critique on CMS' processes and programs

  • Recovery Auditor Report, Issue 9, May 17, 2012

    During the past few months, there have been a number of Office of Inspector General (OIG) reports...

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 9, May 17, 2012

    DCS Healthcare posts one new issue into two categories

Recent Recovery Auditor Activity

  • Medicare Update for CAHs, Issue 10, May 16, 2012

    DCS Healthcare posts one new issue into two categories

Recovery auditor hot topics: Audit MICs struggling to identify overpayments

  • Recovery Auditor Report, Issue 7, April 19, 2012

    On March 20, the Office of Inspector General (OIG) issued a report that presents an early...

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 7, April 19, 2012

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 7, April 19, 2012

    DCS Healthcare posts eight new issues across four categories

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 8, April 18, 2012

    DCS Healthcare posts two new issues for skilled nursing facility claims

Three-day payment window explained

  • Recovery Auditor Report, Issue 6, April 5, 2012

    Join HCPro on Tuesday, April 17, at 1 p.m. (Eastern) for the 90-minute live audio conference...

CMS requires the creation of improper payment edits

  • Recovery Auditor Report, Issue 6, April 5, 2012

    In early March, CMS released two related transmittals that rescinded prior transmittals.

Recent Recovery Auditor activity

  • Recovery Auditor Report, Issue 6, April 5, 2012

    DCS Healthcare posts three new issues across two categories

Important Medicare updates

  • Medicare Update for CAHs, Issue 7, April 4, 2012

    CMS redesigns claims and benefits statement

From the field: CMS Q&A on the discussion period

  • Medicare Update for CAHs, Issue 7, April 4, 2012

    After reading about another provider’s Recovery Auditor correspondence woes in a February 23...

Recent Recovery Auditor activity

  • Medicare Update for CAHs, Issue 7, April 4, 2012

    DCS Healthcare posts new issue for medical necessity claims

Recovery Auditors to increase medical records request limits

  • Recovery Auditor Report, Issue 5, March 22, 2012

    On March 12, CMS issued an update that effectively raises the additional documentation requests...

From the field: CMS Q&A on the discussion period

  • Recovery Auditor Report, Issue 5, March 22, 2012

    After reading about another provider’s Recovery Auditor correspondence woes in a February 23...

CAHs take notice: Certain improper payment edits required by July 1

  • Medicare Update for CAHs, Issue 6, March 21, 2012

    CMS recently released two replacement transmittals that summarize Recovery Auditor-identified...

Recovery auditor hot topics: esMD

  • Recovery Auditor Report, Issue 4, March 8, 2012

    The following article is part one in a series covering various topics in the world of recovery...

Q&A with Debbie Mackaman: Recovery auditors and more

  • Recovery Auditor Report, Issue 4, March 8, 2012

    What type of impact do you think the newly announced demonstration project for recovery auditor...

Recent recovery auditor activity

  • Medicare Update for CAHs, Issue 5, March 7, 2012

    HealthDataInsights posts seven new issues for medical necessity claims

CMS posts year-end improper payment figures, top issues by region

  • Recovery Auditor Report, Issue 3, February 23, 2012

    On February 9, CMS posted its latest recovery auditor update. The results show a continuing trend...

Recent recovery auditor activity

  • Recovery Auditor Report, Issue 3, February 23, 2012

    DCS Healthcare posts new issue for DME supplier claims

Q&A with Debbie Mackaman: Recovery auditors and more

  • Medicare Update for CAHs, Issue 4, February 22, 2012

    What type of impact do you think the newly announced demonstration project for recovery auditor...

Medicare Membership Program

  • Recovery Auditor Report, Issue 3, February 9, 2012

    Get answers to your questions and Medicare compliance guidance from the experts all year long.

Start date announced for recovery audit prepayment review demo

  • Recovery Auditor Report, Issue 3, February 9, 2012

    On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...

Recovery audits result in changes to CMS systems and recoupment options

  • Recovery Auditor Report, Issue 3, February 9, 2012

    This week CMS published two transmittals that affect CMS systems as a result of the recovery audit...

Recent recovery auditor activity

  • Recovery Auditor Report, Issue 3, February 9, 2012

    Connolly adds 17 new issues across five categories

Recent RAC activity

  • Medicare Update for CAHs, Issue 3, February 8, 2012

    HealthDataInsights posts 33 new issues for medical necessity claims

Start date announced for recovery audit prepayment review demo

  • Medicare Update for CAHs, Issue 3, February 8, 2012

    On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...

CMS posts Q4 improper payment figures, top issues by region

  • Recovery Auditor Report, Issue 2, January 26, 2012

    Each quarter CMS issues a recovery audit program update that details the total amount of...

CMS posts new quarterly provider compliance newsletter

  • Recovery Auditor Report, Issue 2, January 26, 2012

    In its most recent (January 20) Medicare Quarterly Provider Compliance Newsletter, CMS once again...

From the field: The demand letter problem grows

  • Recovery Auditor Report, Issue 2, January 26, 2012

    A RAC coordinator at a hospital in Region B (who wished to remain anonymous) shared one of her...

Recent RAC activity

  • Recovery Auditor Report, Issue 2, January 26, 2012

    DCS Healthcare posts 25 new issues for medical necessity claims

Confusing the rebuttal process with the discussion period

  • Medicare Update for CAHs, Issue 2, January 25, 2012

    The following question and answer is an exchange between a reader and the Revenue Cycle Institute...

Recent RAC activity

  • Medicare Update for CAHs, Issue 2, January 25, 2012

    DCS Healthcare posts 25 new issues for medical necessity claims

From the field: Chasing clues on demand letters

  • Recovery Auditor Report, Issue 1, January 12, 2012

    A RAC coordinator at a hospital in Region C (who wished to remain anonymous) shared one of her...

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 1, January 12, 2012

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Recent RAC activity

  • Recovery Auditor Report, Issue 1, January 12, 2012

    DCS Healthcare posts 40 new issues for medical necessity claims

CMS releases details of recovery auditor prepayment review demonstration

  • Medicare Update for CAHs, Issue 1, January 11, 2012

    On November 15, CMS announced that it will launch a number of demonstration programs starting in...

CMS to delay two of out three new demonstration projects aimed at reducing improper payments

  • Medicare Update for CAHs, Issue 1, January 11, 2012

    On December 29, CMS issued a notice announcing the delay of the recovery audit prepayment review...

Recent RAC activity

  • Medicare Update for CAHs, Issue 2, January 11, 2012

    DCS Healthcare posts 54 new issues across two categories

CMS releases details of recovery auditor prepayment review demonstration

  • Recovery Auditor Report, Issue 26, December 29, 2011

    On November 15, CMS announced that it will launch a number of demonstration programs that are set...

Recent RAC activity

  • Recovery Auditor Report, Issue 26, December 29, 2011

    DCS Healthcare posts 45 new issues across two categories

Refresher: Quick reference appeals time limits

  • Medicare Update for CAHs, Issue 14, December 28, 2011

    Time limit for filing an appeal after:

HCPro's 2011 Recovery Auditor Benchmarking Survey

  • Recovery Auditor Report, Issue 25, December 15, 2011

    Be part of a comprehensive assessment of the recovery auditor program and learn how facilities...

From the field: Demand letter confusion

  • Recovery Auditor Report, Issue 25, December 15, 2011

    A compliance director at a hospital in Region C (who wished to remain anonymous) shared one of her...

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 25, December 15, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

From the field: Physician order claim denial to favorable result

  • Medicare Update for CAHs, Issue 13, December 14, 2011

    A RAC coordinator in Region C recently reached out to Kimberly Anderwood Hoy, JD, CPC, director of...

The three-day payment window and new PD modifier

  • Recovery Auditor Report, Issue 24, December 1, 2011

    Last week was rather quiet for CMS, so I wanted to bring forward guidance that CMS published in the...

Recent RAC activity

  • Recovery Auditor Report, Issue 24, December 1, 2011

    DCS Healthcare posts 66 new issues for medical necessity claims

CMS finalizes physician supervision proposals

  • Medicare Update for CAHs, Issue 12, November 30, 2011

    When the 2012 outpatient prospective payment system (OPPS) proposed rule was released, there were a...

CMS announces major efforts to help reduce Medicare, Medicaid improper payments

  • Medicare Update for CAHs, Issue 12, November 30, 2011

    As part of the ongoing effort to reduce improper payments in Medicare and Medicaid, CMS announced...

Recent RAC activity

  • Medicare Update for CAHs, Issue 12, November 30, 2011

    DCS Healthcare posts 66 new issues for medical necessity claims

CMS announces major efforts to help reduce Medicare, Medicaid improper payments

  • Recovery Auditor Report, Issue 23, November 17, 2011

    As part of the ongoing effort to reduce improper payments in Medicare and Medicaid, CMS announced...

Recent RAC activity

  • Recovery Auditor Report, Issue 23, November 17, 2011

    DCS Healthcare posts 36 new issues for medical necessity claims

CMS launches second volume of quarterly compliance newsletter

  • Medicare Update for CAHs, Issue 11, November 16, 2011

    CMS issued the initial release of the second volume of Medicare Quarterly Compliance Newsletters...

Recent RAC activity

  • Medicare Update for CAHs, Issue 11, November 16, 2011

    DCS Healthcare posts 36 new issues for medical necessity claims

CMS launches second volume of quarterly compliance newsletter

  • Recovery Auditor Report, Issue 22, November 3, 2011

    CMS issued the initial release of the second volume of Medicare Quarterly Compliance Newsletters...

AHA to host November conference calls with CMS and RAC representatives

  • Recovery Auditor Report, Issue 22, November 3, 2011

    The American Hospital Association (AHA) will host four members-only conference calls—one for...

Recent RAC activity

  • Recovery Auditor Report, Issue 22, November 3, 2011

    DCS Healthcare posts 20 new issues for medical necessity claims

Recent RAC activity

  • Medicare Update for CAHs, Issue 10, November 2, 2011

    DCS Healthcare adds 20 new issues for medical necessity claims

Medical necessity and RAC tracking management best practices

  • Recovery Auditor Report, Issue 21, October 20, 2011

    The following a checklist of best practice techniques when it comes to medical necessity and RAC...

Recent RAC activity

  • Recovery Auditor Report, Issue 21, October 20, 2011

    CGI posts new issue for DME claims

The RAC Toolkit for Physician Practices

  • Recovery Auditor Report, Issue 21, October 20, 2011

    RACs are auditing practices. Learn how to prepare.

Recent RAC activity

  • Medicare Update for CAHs, Issue 4, October 19, 2011

    DCS Healthcare posts four new issues for medical necessity claims

Q&A: Three-day payment window

  • Recovery Auditor Report, Issue 19, October 6, 2011

    The following is adapted from an actual Q&A between a listener from an HCPro audio conference...

RAC readiness for automated reviews

  • Recovery Auditor Report, Issue 20, October 6, 2011

    While automated reviews do not require medical record (MR) review, they are the most difficult to...

Recent RAC activity

  • Recovery Auditor Report, Issue 20, October 6, 2011

    DCS Healthcare posts four new issues for medical necessity claims

Revised RAC statement of work: Impact on providers

  • Medicare Update for CAHs, Issue 8, October 5, 2011

    CMS released a revised recovery audit contractor (RAC) statement of work (SOW) September 12 that...

CMS releases Medicaid RACs final rule

  • Medicare Update for CAHs, Issue 8, October 5, 2011

    In February, the Centers for Medicare and Medicaid Services (CMS) delayed its expected April 1...

Recent RAC activity

  • Recovery Auditor Report, Issue 19, September 22, 2011

    CGI posts new issue for professional claims

Recent RAC activity

  • Medicare Update for CAHs, Issue 7, September 21, 2011

    Recent RAC activity

Assessing and quantifying your risk for RAC recoupments

  • Recovery Auditor Report, Issue 18, September 8, 2011

    Editor’s note: This article was excerpted from the new HCPro book, “The RAC Toolkit for...

Recent RAC activity

  • Recovery Auditor Report, Issue 18, September 8, 2011

    CGI posts new issue for professional claims

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 18, September 8, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

2012 IPPS Final Rule Explained

  • Recovery Auditor Report, Issue 18, September 8, 2011

    The sheer volume of new payment information in the 2012 IPPS Rule makes the rule difficult to...

Important Medicare updates

  • Medicare Update for CAHs, Issue 6, September 7, 2011

    CMS instructs on ICD-10 billing, processing

Recent RAC activity

  • Medicare Update for CAHs, Issue 6, September 7, 2011

    CGI posts new issue for professional claims

Medicare compliance: Let the rules fuel your decisions

  • Recovery Auditor Report, Issue 17, August 25, 2011

    When you understand Medicare's rules and regulations you'll create a solid foundation to protect...

Additional documentation limits raised for certain providers

  • Recovery Auditor Report, Issue 17, August 25, 2011

    As of August 22, recovery auditors can request up to 35 records per 45 days from non-supplier and...

Recent RAC activity

  • Recovery Auditor Report, Issue 17, August 25, 2011

    CGI posts three new issues across two categories

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 17, August 25, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Demand letter responsibility shifted from RAC to MAC

  • Medicare Update for CAHs, Issue 5, August 24, 2011

    Recovery audit contractors had previously been responsible for issuing demand letters to providers...

Important Medicare updates

  • Medicare Update for CAHs, Issue 5, August 24, 2011

    CMS posts telemedicine survey letter

Additional documentation limits increase for certain providers

  • Medicare Update for CAHs, Issue 3, August 24, 2011

    As of August 22, recovery auditors can request up to 35 records per 45 days from non-supplier and...

Recent RAC activity

  • Medicare Update for CAHs, Issue 5, August 24, 2011

    CGI posts three new issues across two categories  

Demand letter responsibility shifted from RAC to MAC

  • Recovery Auditor Report, Issue 16, August 11, 2011

    Recovery audit contractors had previously been responsible for issuing demand letters to providers...

CMS posts IPPS final rule for FY 2012

  • Recovery Auditor Report, Issue 16, August 11, 2011

    CMS has released a display copy of the IPPS final rule for fiscal year (FY) 2012.

Recent RAC activity

  • Recovery Auditor Report, Issue 16, August 11, 2011

    DCS Healthcare posts two new issues for medical necessity claims

CMS releases updated improper payment figures, top regional RAC issues

  • Medicare Update for CAHs, Issue 4, August 10, 2011

    CMS released a Recovery Audit Contractor (RAC) update on July 15 that details the amount of...

Recent RAC activity

  • Medicare Update for CAHs, Issue 4, August 10, 2011

    DCS Healthcare posts six new issues for medical necessity claims in Maryland.

Recent RAC activity

  • Recovery Auditor Report, Issue 15, July 28, 2011

    DCS Healthcare posts new issue for DME claims

Combat RAC Denials

  • Recovery Auditor Report, Issue 15, July 28, 2011

    RAC and other government auditor denials continue to mount up and it’s more important than...

Tip: Interpreting PEPPER reports

  • Medicare Update for CAHs, Issue 3, July 27, 2011

    Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports became available to CAHs...

Medicare Membership Program

  • Medicare Update for CAHs, Issue 3, July 27, 2011

    Get answers to your questions and Medicare compliance guidance from the experts all year long.

Recent RAC activity

  • Recovery Auditor Report, Issue 14, July 14, 2011

    DCS Healthcare posts two new issues for medical necessity claims

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 14, July 14, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

CMS discloses DRG coding vulnerabilities for inpatient hospitals

  • Recovery Auditor Report, Issue 13, June 30, 2011

    In an effort to provide helpful information to providers, CMS released a special edition MedLearn...

Provider-friendly change to tracking observation hours

  • Recovery Auditor Report, Issue 13, June 30, 2011

    In the July OPPS update, CMS made a manual change to the section on counting observation hours that...

Recent RAC activity

  • Recovery Auditor Report, Issue 13, June 30, 2011

    DCS Healthcare posts new issue for medical necessity claims

How inpatient-only procedures apply to CAHs

  • Medicare Update for CAHs, Issue 1, June 29, 2011

    Inpatient-only procedures are those that CMS determined may only be safely performed on an...

PEPPER for Critical Access Hospitals

  • Medicare Update for CAHs, Issue 1, June 29, 2011

    Join HCPro on Thursday July 7, 2011, at 1PM (Eastern) for this 90-minutee live audio conference...

Recent RAC activity

  • Medicare Update for CAHs, Issue 1, June 29, 2011

    Here is a summary of recovery audit contractor (RAC) activity from the past two weeks.

CMS issues clarification on services made "under arrangement"

  • Recovery Auditor Report, Issue 12, June 16, 2011

    Editor’s note: This article is the third in a series of three IPPS-related updates.

The new frontier of coverage denials

  • Recovery Auditor Report, Issue 12, June 16, 2011

    This week CMS released a special edition MLN Matters article reviewing the coverage of percutaneous...

Focus on prevention of future recoupments

  • Recovery Auditor Report, Issue 11, June 2, 2011

    The long-term goal for every facility facing RAC should be to avoid RAC recoupments by ensuring...

Recent RAC activity

  • Recovery Auditor Report, Issue 11, June 2, 2011

    DCS Healthcare posts five new issues for medical necessity claims

Three-day rule clarification issued in IPPS proposed rule

  • Recovery Auditor Report, Issue 10, May 19, 2011

    On April 19, CMS released the inpatient prospective payment system proposed rule for 2012, which...

April 27 Hospital & Hospital Quality Open Door Forum Summary

  • Recovery Auditor Report, Issue 10, May 19, 2011

    A representative from the Office of Clinical Standards and Quality suggested to the audience that...

MAC settles long-running inpatient billing debate

  • Recovery Auditor Report, Issue 10, May 19, 2011

    Noridian Administrative Services LLC, Medicare administrative contractor (MAC) for Montana, North...

Recent RAC activity

  • Recovery Auditor Report, Issue 10, May 19, 2011

    DCS Healthcare posts three new issues for medical necessity claims

CMS identifies total improper payment figures; top RAC issue per region

  • Recovery Auditor Report, Issue 9, May 5, 2011

    CMS released a short but useful Recovery Audit Contractor (RAC) update on its website that reports...

CMS issues latest quarterly provider compliance newsletter

  • Recovery Auditor Report, Issue 9, May 5, 2011

    CMS and the Medicare Learning Network (MLN) released the third Medicare Quarterly Provider...

PRIT: Rescind RAC audit of infusion code claims

  • Recovery Auditor Report, Issue 9, May 5, 2011

    On April 27, the physician regulatory issues team (PRIT) discussed the audit of infusion code...

New! Revenue Cycle Institute releases CDI-RAC White Paper

  • Recovery Auditor Report, Issue 9, May 5, 2011

    The Revenue Cycle Institute has released a new white paper, “RAC Preparedness: Five Ideas for...

Recent RAC activity

  • Recovery Auditor Report, Issue 9, May 5, 2011

    DCS Healthcare posts 23 new issues for medical necessity claims

From the field: Discovering errors when receiving an ADR

  • Recovery Auditor Report, Issue 8, April 21, 2011

    While reviewing medical records as part of an additional documentation request, a RAC coordinator...

Recent RAC activity

  • Recovery Auditor Report, Issue 8, April 21, 2011

    DCS Healthcare posts three new issues for medical necessity claims

RACs using 'semi-automated' claims review

  • Recovery Auditor Report, Issue 7, April 7, 2011

    Providers familiar with automated claims reviews and complex claims reviews by the recovery audit...

Recent RAC activity

  • Recovery Auditor Report, Issue 7, April 7, 2011

    DCS Healthcare posts seven new issues for DRG validation claims

CMS podcast addresses high-risk medical necessity vulnerabilities

  • Recovery Auditor Report, Issue 7, April 7, 2011

    CMS’ Medicare Learning Network® has released the first in a series of podcasts designed...

Join a community to talk all things audit

  • Recovery Auditor Report, Issue 7, April 7, 2011

    Whether you are in the midst of them or you are patiently waiting, the fact remains that audits are...

GAO study identifies strategies for CMS to reduce improper payments, offers Medicaid RAC program update

  • Recovery Auditor Report, Issue 6, March 24, 2011

    A Government Accountability Office (GAO) study released March 9 identifies five ways in which GAO...

CMS instructs on coding of place of service codes

  • Recovery Auditor Report, Issue 6, March 24, 2011

    On March 9, CMS released a special edition MLN Matters article that highlights the importance of...

February 23 Hospital & Hospital Quality Open Door Forum Summary

  • Recovery Auditor Report, Issue 6, March 24, 2011

    Pre-existing condition insurance plans A representative from the Centers of Consumer Information...

Recent RAC Activity

  • Recovery Auditor Report, Issue 6, March 24, 2011

    Connolly posts six new RAC issues across six categories

AHA weighs in on Part C RACs

  • Recovery Auditor Report, Issue 5, March 10, 2011

    On February 23, the American Hospital Association (AHA) issued a letter to CMS regarding the...

Q&A: Re-billing an account after a late query response

  • Recovery Auditor Report, Issue 5, March 10, 2011

    Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to...

CMS raises documentation request limits for certain hospitals

  • Recovery Auditor Report, Issue 5, March 10, 2011

    CMS recently increased the number of medical records that recovery audit contractors (RAC) can...

Recent RAC activity

  • Recovery Auditor Report, Issue 5, March 10, 2011

    DCS Healthcare posts 29 new issues across two categories

CMS announces electronic data submission tool for providers

  • Recovery Auditor Report, Issue 4, February 24, 2011

    As it currently stands, providers respond to documentation requests from review contractors such as...

New! Revenue Cycle Institute releases Three-Day Rule White Paper

  • Recovery Auditor Report, Issue 4, February 24, 2011

    The Revenue Cycle Institute has released a new white paper, “Master the Intricacies of the...

CMS issues second quarterly provider compliance newsletter

  • Recovery Auditor Report, Issue 4, February 24, 2011

    CMS and the Medicare Learning Network (MLN) released the second Medicare Quarterly Provider...

CMS delays Medicaid RAC implementation

  • Recovery Auditor Report, Issue 4, February 24, 2011

    As some expected, the expansion of Medicaid recovery audit contractors (RAC) is proving difficult.

CMS releases additional documentation request limits for physicians/non-physician practitioners

  • Recovery Auditor Report, Issue 4, February 24, 2011

    In response to feedback from the RACs, physicians and their associations, CMS modified the...

From the field: Inpatient admission date and time compliance

  • Recovery Auditor Report, Issue 3, February 10, 2011

    This past summer when the first Recovery Audit Contractor (RAC) approved the issue “inpatient...

January 12 Hospital & Hospital Quality Open Door Forum Summary

  • Recovery Auditor Report, Issue 3, February 10, 2011

    A CMS representative began the presentation portion of the call by talking about admissions...

Recent RAC activity

  • Recovery Auditor Report, Issue 3, February 10, 2011

    CGI removes four DRG validations issues

HCPro Watchdog Service

  • Recovery Auditor Report, Issue 3, February 10, 2011

    Providers and payers alike have to stay on top of a regulatory environment that is constantly...

RAC talk: A few minutes with Nancy Beckley

  • Recovery Auditor Report, Issue 2, January 27, 2011

    Name: Nancy J. Beckley, MS, MBA, CHC Title: President  

Recent RAC Activity

  • Recovery Auditor Report, Issue 2, January 27, 2011

    DCS Healthcare posts seven new issues for DRG validation claims

CMS issues FAQ on 60-day determination requirement

  • Recovery Auditor Report, Issue 2, January 27, 2011

    CMS has posted the following frequently asked question:

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 2, January 27, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

RAC talk: A few minutes with Stacey Levitt

  • Recovery Auditor Report, Issue 1, January 13, 2011

    Name: Stacey Levitt, RN, MSN, CPC Title: Senior Administrative Director of Patient Care...

Recent RAC activity

  • Recovery Auditor Report, Issue 1, January 13, 2011

    HealthDataInsights adds four new issues for Part A inpatient claims review

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 1, January 13, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Medicare Membership Program

  • Recovery Auditor Report, Issue 1, January 13, 2011

    Get answers to your questions and Medicare compliance guidance from the experts all year long. Join...

RAC talk: A few minutes with Bill Malm

  • Recovery Auditor Report, Issue 24, December 30, 2010

    Name: William Malm, ND, RN Title: Healthcare consultant  

AHA comments on Medicaid RAC proposed rule

  • Recovery Auditor Report, Issue 24, December 30, 2010

    On December 20, the American Hospital Association (AHA) issued a letter to CMS containing comments...

CMS soliciting comments for development of Part C and Part D RAC programs

  • Recovery Auditor Report, Issue 24, December 30, 2010

    On December 27, CMS issued in the Federal Register a notice that presents an approach and requests...

Make sense of Medicaid RACs

  • Recovery Auditor Report, Issue 24, December 30, 2010

    Signs are pointing to the fact that Medicaid RACs might not be the stuff of unicorns or Santa Claus.

Recent RAC activity

  • Recovery Auditor Report, Issue 24, December 30, 2010

    HealthDataInsights adds two new issues across two categories

CMS publishes RAC improper payment vulnerabilities for physicians

  • Recovery Auditor Report, Issue 23, December 16, 2010

    Continuing in its endeavor to publicize valuable information derived from the RAC demonstration...

RAC Talk: A few minutes with Yvonne Focke

  • Recovery Auditor Report, Issue 23, December 16, 2010

    Name: Yvonne Focke, RN, BSN, MBA

CMS now requiring ABN review as part of ADR

  • Recovery Auditor Report, Issue 23, December 16, 2010

    CMS released a transmittal on December 10 that will require that a mandatory advanced beneficiary...

New! Revenue Cycle Institute releases 2010 RAC Benchmark Report

  • Recovery Auditor Report, Issue 23, December 16, 2010

    The Revenue Cycle Institute has released a new white paper, “RAC Preparedness Benchmarking...

Recent RAC Activity

  • Recovery Auditor Report, Issue 23, December 16, 2010

    DCS Healthcare adds 23 issues across four categories

Revenue Cycle Institute issues free monthly tool

  • Recovery Auditor Report, Issue 23, December 16, 2010

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

RAC talk: A few minutes with Elizabeth Lamkin

  • Recovery Auditor Report, Issue 22, December 2, 2010

    Name: Elizabeth Lamkin Title: President  

From the field: Recoupment before receipt of demand letters

  • Recovery Auditor Report, Issue 22, December 2, 2010

    The Revenue Cycle Institute recently had a brief conversation with Karen Sagen, managed care leader...

CMS releases additional documentation request limits for providers

  • Recovery Auditor Report, Issue 22, December 2, 2010

    On November 10, CMS-in response to feedback from the RACs, providers/suppliers and their...

Recent RAC activity

  • Recovery Auditor Report, Issue 22, December 2, 2010

    CGI adds new RAC issue in two separate categories

CMS takes first step toward Medicaid RAC implementation

  • Recovery Auditor Report, Issue 21, November 11, 2010

    CMS released the long-anticipated proposed rule for Medicaid recovery audit contractors (RACs...

RAC talk: A few minutes with Nancy Hirschl

  • Recovery Auditor Report, Issue 21, November 11, 2010

    Name: Nancy Hirschl, B.S., CCS Title: President  

October 7, 2010 Hospital & hospital quality open door forum summary

  • Recovery Auditor Report, Issue 21, November 11, 2010

    Hospital quality update A CMS representative informed the audience that the hospital-acquired...

Talking RACs with Kimberly Anderwood Hoy

  • Recovery Auditor Report, Issue 20, October 28, 2010

    What was one of most common front-end problems hospitals may have had that led to RAC audits and/or...

CMS implements hospital-friendly reforms to Medicaid Integrity Program

  • Recovery Auditor Report, Issue 20, October 28, 2010

    On October 25, AHA News Now published information on a new CMS policy that prohibits Medicaid...

OIG reviews CMS use of error rate data

  • Recovery Auditor Report, Issue 20, October 28, 2010

    This week the OIG issued a report criticizing CMS’ use of the error rate data that they...

Recent RAC Activity

  • Recovery Auditor Report, Issue 20, October 28, 2010

    CGI adds new issue for DME claims

CMS launches first quarterly newsletter on avoiding common billing errors

  • Recovery Auditor Report, Issue 19, October 14, 2010

    CMS and the Medicare Learning Network (MLN) recently released the Medicare Quarterly Provider...

A few minutes with Donna Wilson

  • Recovery Auditor Report, Issue 19, October 14, 2010

    Name: Donna Wilson, RHIA, CCS

Recent RAC activity

  • Recovery Auditor Report, Issue 19, October 14, 2010

    CGI posts new RAC issues CGI, the RAC for Region B, added two new issues for professional...

CMS issues letter to state Medicaid directors on RAC expansion

  • Recovery Auditor Report, Issue 19, October 14, 2010

    As previously discussed, CMS has been laying groundwork for the expansion of RACs into Medicaid.

CMS publishes RAC improper payment vulnerabilities

  • Recovery Auditor Report, Issue 18, September 30, 2010

    In an effort to propagate useful information on RAC high-dollar improper payment vulnerabilities...

Medical Necessity RAC Strategies

  • Recovery Auditor Report, Issue 18, September 30, 2010

    After much anticipation, they’ve finally arrived. With the recent CMS approval of issues for...

Recent RAC Activity

  • Recovery Auditor Report, Issue 18, September 30, 2010

    DCS Healthcare posts new issue

August 26, 2010 CMS Hospital and Hospital Quality Open Door Forum summary

  • Recovery Auditor Report, Issue 18, September 30, 2010

    Hospital quality update

Manage medical necessity and improve appeals

  • Recovery Auditor Report, Issue 18, September 30, 2010

    The waiting is over. CMS has approved medical necessity RAC issues, creating a new challenge for...

CMS changes guidance on the date of service reporting for three-day payment window

  • Recovery Auditor Report, Issue 17, September 16, 2010

    CMS released through one of their provider listservs last week revised guidance on reporting the...

Recent RAC activity

  • Recovery Auditor Report, Issue 17, September 16, 2010

    DCS Healthcare adds first medical necessity issues for review

From the field: Share your RAC story

  • Recovery Auditor Report, Issue 17, September 16, 2010

    Help us to understand your RAC experience.  

Q&A: Academic medical center RAC vulnerabilities

  • Recovery Auditor Report, Issue 17, September 16, 2010

    Question: Are academic programs that practice more evidence-based medicine at a lower risk of audit...

CMS laying groundwork for Medicaid RACs

  • Recovery Auditor Report, Issue 17, September 16, 2010

    In a sign that can be viewed as the first step toward Medicaid RAC implementation, CMS released...

Seven tips for RAC Region D providers

  • Recovery Auditor Report, Issue 16, September 2, 2010

    Let’s face it; RACs are an albatross around the neck of susceptible providers.

Take advantage of nine tips for RAC appeal success

  • Recovery Auditor Report, Issue 16, September 2, 2010

    According to a July HCPro survey of approximately 500 healthcare providers, 56% have already...

Recent RAC Activity

  • Recovery Auditor Report, Issue 16, September 2, 2010

    DCS Healthcare posts two new RAC issues

Seven Tips For RAC Region A Providers

  • Recovery Auditor Report, Issue 16, September 2, 2010

    Diversified Collection Services (DCS) began its affiliation with the RAC program when CMS awarded...

CMS approves 18 medical necessity issues for RAC review

  • Recovery Auditor Report, Issue 15, August 19, 2010

    Finally, the wait is over. The first set of approved medical necessity issues were posted August 12...

Eight concepts to consider regarding the three-day rule

  • Recovery Auditor Report, Issue 15, August 19, 2010

    With the release of the 2011 IPPS final rule on July 30 comes a number of changes that providers...

CMS responds to OIG review of rehab facilities

  • Recovery Auditor Report, Issue 15, August 19, 2010

    Inpatient rehabilitation facilities (IRF) were the recent target of two OIG reviews.

Recent RAC Activity

  • Recovery Auditor Report, Issue 15, August 19, 2010

    DCS Healthcare posts 10 new RAC issues for non-medical necessity inpatient claims

July 15 CMS Hospital and Hospital Quality Open Door Forum summary

  • Recovery Auditor Report, Issue 15, August 19, 2010

    A CMS representative informed the audience that the preview period for the September 2010 hospital...

CMS issues final rule for payment error rate measurement for Medicaid and CHIP

  • Recovery Auditor Report, Issue 15, August 19, 2010

    On August 10, CMS released the final regulations that will fully implement improvements to the...

Inpatient admissions decision fuels RAC uncertainty

  • Recovery Auditor Report, Issue 16, August 5, 2010

    Recent approval of a Region C RAC issue for inpatient hospital claims review has initiated...

RACs deny post-discharge queries

  • Recovery Auditor Report, Issue 16, August 5, 2010

    The provider community is reporting a new trend of late: RACs are denying post-discharge queries...

Recent RAC activity

  • Recovery Auditor Report, Issue 16, August 5, 2010

    Connolly adds nine new RAC issues across three categories

CMS posts new RAC questions and answers

  • Recovery Auditor Report, Issue 16, August 5, 2010

    CMS posts new RAC questions and answers

CMS release highlights RAC vulnerabilities

  • Recovery Auditor Report, Issue 15, July 22, 2010

    On July 12, CMS released a special edition MLN Matters article that is “the first in a series...

Revenue Cycle Institute issues clarification regarding three-day rule

  • Recovery Auditor Report, Issue 15, July 22, 2010

    The Revenue Cycle Institute has become aware of published information that might be misleading or...

Five front-end tips to consider for Region C providers

  • Recovery Auditor Report, Issue 15, July 22, 2010

    Each regional recovery audit contractor (RAC) differs in its approach when it comes to dealing with...

Recent RAC activity

  • Recovery Auditor Report, Issue 15, July 22, 2010

    CGI adds three new RAC issues for DRG validation claims

RAC vulnerabilities highlighted in CMS release

  • HCPRO Website, Issue 0, July 14, 2010

    On July 12, CMS released a special edition MLN Matters article that is “the first in a series...

Hospitals face three-day payment window changes

  • Recovery Auditor Report, Issue 14, July 8, 2010

    Hospitals clamoring for guidance from CMS about the three-day payment window must now grapple with...

CMS update indicates high provider success rate for appealing denials

  • Recovery Auditor Report, Issue 13, June 24, 2010

    A recently released report titled “The Medicare RAC Program: Update to the evaluation of the...

Recent RAC Activity

  • Recovery Auditor Report, Issue 13, June 24, 2010

    DCS Healthcare posts 23 new RAC issues

Missing RAC records: Another snag thrown at providers

  • Recovery Auditor Report, Issue 13, June 24, 2010

    In the increasingly stressful realm of RAC coordination the last thing providers need is additional...

Reduce RAC vulnerabilities with a quality CDI program

  • Recovery Auditor Report, Issue 13, June 24, 2010

    DRG (diagnosis-related groups) validation issues have been the main target of RACs nationwide in...

OIG continues to review oxaliplatin billing

  • Recovery Auditor Report, Issue 13, June 24, 2010

    On June 17, the OIG issued a review of oxaliplatin billing errors at Parkland Health and Hospital...

RAC: The Problem With The Three-Day Rule

  • Recovery Auditor Report, Issue 12, June 10, 2010

    The three-day rule is the subject of a provision in the American Jobs and Closing Tax Loopholes...

Providers leaning on tracking software as RACS press on

  • Recovery Auditor Report, Issue 12, June 10, 2010

    With the growing number of CMS-approved RAC issues and the impending medical necessity audits on...

2010 RAC Benchmarking Survey

  • Recovery Auditor Report, Issue 12, June 10, 2010

    Be part of a comprehensive assessment of the Recovery Audit Contractor (RAC) program and how...

RAC Appeals: Master the Process and Overturn Denials

  • Recovery Auditor Report, Issue 12, June 10, 2010

    During this 90-minute live audio conference on Thursday June 24, you will learn how to appeal RAC...

Recent RAC Activity

  • Recovery Auditor Report, Issue 11, May 27, 2010

    DCS Healthcare posts 3 new RAC issues for DRG validation review

More than just RACs: Hospital shares its MIC experience

  • Recovery Auditor Report, Issue 11, May 27, 2010

    As MIC audits begin to hit home with providers, the initial doubts and concerns that came earlier...

Proposed amendment takes aim at RAC issues in three-day rule

  • Recovery Auditor Report, Issue 11, May 27, 2010

    The three-day rule is the subject of a provision in the American Jobs and Closing Tax Loopholes...

CMS posts additional guidance regarding complex review

  • Recovery Auditor Report, Issue 11, May 27, 2010

    A recently released transmittal from CMS adds direct language to the Medicare Program Integrity...

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 11, May 27, 2010

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

2010 RAC Benchmarking Survey

  • Recovery Auditor Report, Issue 11, May 27, 2010

    Be part of a comprehensive assessment of the Recovery Audit Contractor (RAC) program and how...

Prepare for impending RAC medical necessity reviews

  • Recovery Auditor Report, Issue 10, May 13, 2010

    There has been much speculation as to when providers would see the first wave of medical necessity...

PSST! CMS says medical necessity, physician complex audits on their way

  • Recovery Auditor Report, Issue 10, May 13, 2010

    On the May 12 RAC 101 call for physicians, a caller asked CMS specific information about when...

RAC 101 Q&A fields questions from providers nationwide

  • Recovery Auditor Report, Issue 10, May 13, 2010

    The first of four scheduled nationwide RAC calls was held on April 28 and touched on a number of...

Recent change in CMS manual aims to improve RAC program

  • Recovery Auditor Report, Issue 10, May 13, 2010

    A recent transmittal released by CMS implemented a number of changes to the Medicare Financial...

CMS releases RAC related transmittals

  • Recovery Auditor Report, Issue 10, May 13, 2010

    CMS updates MAC business requirements regarding RACs

Recent RAC activity

  • Recovery Auditor Report, Issue 9, April 29, 2010

    Connolly Healthcare posts 20 new RAC issues for non-medical necessity DRG validation reviews

CMS seeks to end remittance advice confusion

  • Recovery Auditor Report, Issue 9, April 29, 2010

    In a recently released transmittal, CMS has addressed an issue that has been a thorn in the side...

Condition Code 44: Finding success in changes of level of care

  • Recovery Auditor Report, Issue 9, April 29, 2010

    Managing condition code 44 is complex; and knowing that the RACs will be looking at a...

From The Field: RAC experiences

  • Recovery Auditor Report, Issue 9, April 29, 2010

    A corporate compliance professional from a hospital in Indiana, who wished to remain anonymous...

Revenue Cycle posts free monthly tool

  • Recovery Auditor Report, Issue 9, April 29, 2010

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Recent RAC Activity

  • Recovery Auditor Report, Issue 8, April 15, 2010

    CGI adds two new issues for medically unlikely edits (outpatient and professional)...  

From The Field: RAC experiences

  • Recovery Auditor Report, Issue 8, April 15, 2010

    An anonymous reader shared with us their RAC experience, and had this to say:

GAO examines RAC vulnerabilities

  • Recovery Auditor Report, Issue 8, April 15, 2010

    According to a new Government Accountability Office (GAO) report, CMS has failed to take...

CMS reaching out to providers on RAC issues

  • Recovery Auditor Report, Issue 8, April 15, 2010

    CMS announced a series of nationwide RAC 101 calls.

Recent RAC Activity

  • Recovery Auditor Report, Issue 7, April 1, 2010

    DCS Healthcare posts 3 new issues for DRG validation reviews

Finding success in the RAC discussion period

  • Recovery Auditor Report, Issue 7, April 1, 2010

    Since the implementation of the permanent RAC program, providers may not be taking full advantage...

CMS publishes provider option chart

  • Recovery Auditor Report, Issue 7, April 1, 2010

    CMS has published a useful chart detailing provider options for RAC overpayment determinations.

Appeals council issues a ?partially favorable? decision

  • Recovery Auditor Report, Issue 7, April 1, 2010

    The Medicare Appeals Council has issued a decision on one of the many outstanding appeals from the...

Connolly posts 25 new RAC issues for non-medical necessity DRG validation

  • Recovery Auditor Report, Issue 6, March 18, 2010

    Connolly Healthcare added 25 RAC issues for non-medical necessity DRG validation reviews review to...

RAC audits now a potential risk for physicians

  • Recovery Auditor Report, Issue 6, March 18, 2010

    Earlier this year, two of the four RACs added Medically Unlikely Edits (MUE) to their list of...

Combat potential undercoding due to fear of RAC denials

  • Recovery Auditor Report, Issue 6, March 18, 2010

    Although many providers have tried to curb undercoding over the years, the flurry of activity from...

White House memorandum mandates additional recovery audits

  • Recovery Auditor Report, Issue 6, March 18, 2010

    A March 10 White House memorandum on finding and recapturing improper payments has mandated...

Revenue Cycle Institute posts free monthly tool

  • Recovery Auditor Report, Issue 6, March 18, 2010

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Recent RAC Activity

  • Recovery Auditor Report, Issue 5, March 4, 2010

    DCS Healthcare added a new issue for DME supplier’s claims to its CMS-approved list this week...

Admit it: Admission orders important in era of audits

  • Recovery Auditor Report, Issue 5, March 4, 2010

    Admission orders are an important area of focus for auditors charged with the responsibility for...

Understanding and Avoiding RAC Fraud

  • Recovery Auditor Report, Issue 5, March 4, 2010

    While RACs are not responsible for reviewing claims for potential fraud, they are responsible for...

RAC extrapolation: Potential impact and how to prepare

  • Recovery Auditor Report, Issue 5, March 4, 2010

    During the demonstration project, RACs chose not to apply the process of extrapolation, and while...

RACs not authorized to review all IRF claims

  • Recovery Auditor Report, Issue 5, March 4, 2010

    CMS has notified notified the AHA that RACs have not been authorized to review all inpatient...

The year of the audit

  • Recovery Auditor Report, Issue 5, March 4, 2010

    The March issue of the Journal of AHIMA features a cover story that discusses why 2010 is...

Recent RAC Activity

  • Recovery Auditor Report, Issue 4, February 18, 2010

    Connolly Healthcare, HealthDataInsights, CGI post new RAC issues.

Dealing with Audit MICs from start to finish

  • Recovery Auditor Report, Issue 4, February 18, 2010

    By now providers nationwide are certainly familiar with Recovery Audit Contractors, or RACs. But...

CMS to expand 2010 additional documentation requests limits

  • Recovery Auditor Report, Issue 4, February 18, 2010

    In response to feedback from the RACs, providers, suppliers and their associations, CMS expanded...

Brush up on sequencing as RAC complex reviews get under way

  • Recovery Auditor Report, Issue 4, February 18, 2010

    As RACs begin to roll out complex reviews and request medical record documentation, compliant...

Join a community to talk all things audit

  • Recovery Auditor Report, Issue 4, February 18, 2010

    Whether you are in the midst of them or you are patiently waiting, the fact remains that audits are...

CGI adds new DRG validation issues

  • Recovery Auditor Report, Issue 3, February 4, 2010

    CGI, the RAC for Region B, has added new issues for non-medical necessity DRG-validation inpatient...

A closer look into DRG validation issues

  • Recovery Auditor Report, Issue 3, February 4, 2010

    Last December, the first sets of complex RAC review issues were released. Since then, the list has...

What could the RACs be thinking?

  • Recovery Auditor Report, Issue 3, February 4, 2010

    With so many DRGs under review by all four RACs, it stands to reason providers are wondering...

Share your RAC story

  • Recovery Auditor Report, Issue 3, February 4, 2010

    A reader, who wished to remain anonymous, shared with us their RAC experience, and had this to say:

Revenue Cycle posts free monthly tool

  • Recovery Auditor Report, Issue 3, February 4, 2010

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.

Medicaid Integrity Contractors: We want to hear from you

  • Recovery Auditor Report, Issue 3, February 4, 2010

    Has your organization undergone a Medicaid Integrity Contractor (MIC) audit? If so, we want to hear...

DCS Healthcare posts new RAC issues for ambulance provider claims and DRG validation

  • Recovery Auditor Report, Issue 2, January 21, 2010

    DCS Healthcare has added a new RAC issue for ambulance provider claims to its CMS-approved list for...

CGI posts new RAC issues for Region B states

  • Recovery Auditor Report, Issue 2, January 21, 2010

    CGI has added dozens of new RAC issues for all states in Region B, according to the CGI Web Site...

Connolly posts dozens of new RAC issues for Region C

  • Recovery Auditor Report, Issue 1, January 7, 2010

    Connolly Healthcare has added dozens of new RAC issues for all states in Region C, according to the...

Editor's note: Happy holidays from HCPro, Inc.

  • Recovery Auditor Report, Issue 25, December 24, 2009

    Dear readers, On behalf of HCPro, Inc., and the members of the RAC Report Advisory Board, I...

Providers receive first RAC medical record documentation requests

  • Recovery Auditor Report, Issue 25, December 24, 2009

    Requests for medical records are already arriving in hospital mailboxes following the approval of...

Q&A: Condition code 44 and physician review

  • Recovery Auditor Report, Issue 25, December 24, 2009

    Q: I had a question about the requirement for hospital use of condition code 44. It is my...

Medical records compilation: Handle RAC documentation requests

  • Recovery Auditor Report, Issue 25, December 24, 2009

    The medical record compilation process begins when the RAC makes a request, which must promptly...

Preparing for RACs: Steps to consider

  • Recovery Auditor Report, Issue 25, December 24, 2009

    Taking certain preventive measures can go a long way toward preparing your facility for RAC audits...

DCS Healthcare, HDI post new RAC issues

  • Recovery Auditor Report, Issue 25, December 24, 2009

    DCS Healthcare has added a new RAC issue to its CMS-approved list this week for providers in the...

RAC begins complex DRG validation audits: Medical record documentation requests imminent

  • Recovery Auditor Report, Issue 24, December 10, 2009

    Connolly Healthcare has announced the first issues approved for complex RAC review, so providers in...

CMS changes RAC medical record request limits for DRG validation audits

  • Recovery Auditor Report, Issue 24, December 10, 2009

    CMS has published new documentation request limits for RAC DRG validation audits in 2010. CMS...

HealthDataInsights posts new RAC issue for Part B claims

  • Recovery Auditor Report, Issue 24, December 10, 2009

    HealthDataInsights (HDI) has added a new RAC issues to its CMS-approved list earlier this month for...

Region B RAC adds DME claim issue, expands existing issues to new states

  • Recovery Auditor Report, Issue 24, December 10, 2009

    CGI, the RAC for Region B, has added a new audit issue for DME claims, and updated the previously...

Survival in a new era of enforcement a tall order for hospitals

  • Recovery Auditor Report, Issue 24, December 10, 2009

    The struggling economy has left many hospitals with thin wallets, and government auditors are...

Have you been received a RAC medical record request?

  • Recovery Auditor Report, Issue 24, December 10, 2009

    If you’ve received a RAC medical record request, we want to hear from you. The first two...

Providers report first RAC denials in Florida, South Carolina

  • Recovery Auditor Report, Issue 24, November 25, 2009

    Healthcare providers in several states received their first RAC denials. And Connolly Healthcare...

Revenue Cycle Institute releases free RAC Preparedness Benchmarking Report

  • Recovery Auditor Report, Issue 24, November 25, 2009

    Budgets are tight, but it seems that many healthcare providers are aware that setting aside...

Region D RAC approved to audit modifiers -TC and -26, adds DME issue

  • Recovery Auditor Report, Issue 24, November 25, 2009

    HealthDataInsights (HDI) has been approved by CMS to audit for inappropriate billing related to the...

Understand the issues: RACs and IV hydration audits

  • Recovery Auditor Report, Issue 24, November 25, 2009

    Some of the issues CMS has already approved for review under the RAC permanent program are...

CMS releases five new, updated RAC FAQ

  • Recovery Auditor Report, Issue 24, November 25, 2009

    CMS released several new and updated FAQ on its Web site November 17.

CMS to begin releasing PEPPER data again in 2010

  • Recovery Auditor Report, Issue 24, November 25, 2009

    CMS has contracted with the TMF Health Quality Institute to again release Program for Evaluating...

HealthDataInsights posts several new RAC DME claim issues

  • Recovery Auditor Report, Issue 23, November 12, 2009

    HealthDataInsights (HDI) has added multiple new RAC issues to their CMS-approved list in late...

Could RAC mass adjustment changes mean increase in automatic audits?

  • Recovery Auditor Report, Issue 23, November 12, 2009

    Providers who believe their RAC denials will be limited to 200 every 45 days (corresponding with...

RAC vs. CERT audits: Do you know the difference?

  • Recovery Auditor Report, Issue 23, November 12, 2009

    The Comprehensive Error Rate Testing (CERT) Hospital Payment Monitoring Program is one of the ways...

Region B and D RACs post new issues, all states now approved for audits

  • Recovery Auditor Report, Issue 22, October 29, 2009

    CGI, the RAC for Region B, has posted three new issues for review in Illinois, Indiana, Kentucky...

CMS releases new FAQ on N432

  • Recovery Auditor Report, Issue 22, October 29, 2009

    On October 15 CMS released an FAQ on the appearance of code N432 on remittance advice.

Sneak preview: Comparing appeal rates for RACs vs. claims processing contractors

  • Recovery Auditor Report, Issue 22, October 29, 2009

    The high number of claims determinations appealed was a measure of dissatisfaction with the RAC...

Audits underway, but hospital continues to refine in preparation for RACs

  • Recovery Auditor Report, Issue 22, October 29, 2009

    St. Joseph Medical Center in Houston has been preparing for RACs for months now, says Cucharras...

Escalating Medicare and Medicaid auditing on the horizon

  • Recovery Auditor Report, Issue 22, October 29, 2009

    There’s no question that audit activity is escalating and the healthcare provider community...

AHA RAC Program Update answers provider questions

  • Recovery Auditor Report, Issue 21, October 15, 2009

    As of September 18, all four RACs were conducting automated audits, according to an October 6...

Two new issues for RAC Region D

  • Recovery Auditor Report, Issue 21, October 15, 2009

    HealthDataInsights (HDI) has announced two new issues for region D.

CMS plans appeals town hall meeting

  • Recovery Auditor Report, Issue 21, October 15, 2009

    CMS planned a town hall meeting for November 5 from 1-3:30 p.m. Eastern Time to discuss appeals of...

Five last-minute tips to prepare for RACs

  • Recovery Auditor Report, Issue 21, October 15, 2009

    RACs have begun auditing at this point, and providers in some states may have received their first...

CMS releases new, updated RAC FAQs

  • Recovery Auditor Report, Issue 21, October 15, 2009

    CMS issued the following new RAC FAQ on its Web site September 30: If I am a chain provider whose...

OIG plans to review Medicare, Medicaid auditing programs

  • Recovery Auditor Report, Issue 21, October 15, 2009

    In 2010, the OIG plans to review the progress of many Medicare and Medicaid auditing programs, as...

Have you been audited by a RAC?

  • Recovery Auditor Report, Issue 21, October 15, 2009

    If you’ve been audited by a RAC—for example, if you’ve received a demand letter...

Last RAC announces first issues: DCS posts approved issues for Region A

  • Recovery Auditor Report, Issue 20, October 1, 2009

    DCS Healthcare has released its first CMS-approved issues for audits in Region A. The three issues...

CMS releases new RAC FAQ

  • Recovery Auditor Report, Issue 20, October 1, 2009

    CMS released the following new RAC FAQ September 25: How long is the Recovery Audit Contractor...

Providers seek information on Medicaid Integrity Contractors as aggressive auditing rolls out nationwide

  • Recovery Auditor Report, Issue 20, October 1, 2009

    At this point, thanks to a three-year demonstration project and a plethora of available information...

Revenue Cycle Institute posts new White paper and tool

  • Recovery Auditor Report, Issue 20, October 1, 2009

    The Revenue Cycle Institute has released a new White Paper, “Sepsis and Septicemia: Clear Up...

RAC issues approved for North Carolina

  • Recovery Auditor Report, Issue 19, September 17, 2009

    Connolly, the RAC for Region C, approved several issues for North Carolina providers on September...

Q&A: Medically Unlikely Edits and Once in a Lifetime codes

  • Recovery Auditor Report, Issue 19, September 17, 2009

    Q: Several RACs are looking for once in a lifetime procedure coding errors. Wouldn’t...

CMS releases transmittal on RACs and LCDs

  • Recovery Auditor Report, Issue 19, September 17, 2009

    CMS released on September 11 transmittal 302, which outlines the authority RACs, MACs, and other...

Revenue Cycle Institute launches new Web site, posts new RAC tool

  • Recovery Auditor Report, Issue 19, September 17, 2009

    We’ve gathered the latest RAC information on the CMS-approved RAC issues in each state and...

CGI posts first approved issues for RAC review in Region B

  • Recovery Auditor Report, Issue 18, September 3, 2009

    Region B, get ready. RACs may begin auditing at any time in several Region B states. CGI Federal...

RAC audit issues approved for Alabama, Georgia

  • Recovery Auditor Report, Issue 18, September 3, 2009

    On September 1 Connolly, the RAC for Region C, has approved several issues for which it can audit...

Connolly posts two RAC-approved issues for DME providers

  • Recovery Auditor Report, Issue 18, September 3, 2009

    Connolly, the Region C RAC, has been approved to audit Durable Medical Equipment (DME) providers...

Update: New issues approved for Florida

  • Recovery Auditor Report, Issue 18, September 3, 2009

    Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida, including...

MACs vs. RACs: Could a little friendly competition mean more bad news for healthcare providers?

  • Recovery Auditor Report, Issue 18, September 3, 2009

    What’s the difference between a MAC and a RAC? When it comes to protecting Medicare dollars...

CMS updates RAC FAQ

  • Recovery Auditor Report, Issue 18, September 3, 2009

    CMS updated the three RAC FAQ on August 26.

Revenue Cycle Institute posts free RAC tool

  • Recovery Auditor Report, Issue 18, September 3, 2009

    Are you looking for help writing your RAC appeal letters? If so, the Revenue Cycle Institute hopes...

CGI posts first approved issues for RAC review in Region B

  • HCPRO Website, Issue 1, August 26, 2009

    CGI Federal, the RAC for Region B, has posted its first set of issues eligible for RAC audits in...

Connolly posts issues for review in Florida: Issues differ between Region C states

  • Recovery Auditor Report, Issue 17, August 20, 2009

    Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida. RACs may...

HealthDataInsights launches new RAC Web site, posts issues eligible for audits

  • Recovery Auditor Report, Issue 17, August 20, 2009

    HealthDataInsights, Inc. (HDI), launched its new RAC Web site, and posted the first set of issues...

Self-examination can help ensure compliance with new CMS-approved audit issues

  • Recovery Auditor Report, Issue 17, August 20, 2009

    Connolly and HealthDataInsights (HDI) have released their first set of “approved...

Trivia answer revealed: What do you know about the RAC Validation Contractor?

  • Recovery Auditor Report, Issue 17, August 20, 2009

    Thanks to all who participated in our trivia contest in the previous issue of The RAC Report.

RAC Audits to begin in Region C: Connolly posts issues eligible for RAC review

  • Recovery Auditor Report, Issue 16, August 6, 2009

    Heads up, healthcare providers: Connolly Healthcare, the RAC for Region C, has posted the first set...

Surprise! Voluntary refunds don't protect against RACs

  • Recovery Auditor Report, Issue 16, August 6, 2009

    For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal...

FAQ: Appealing automated reviews

  • Recovery Auditor Report, Issue 16, August 6, 2009

    Q: Can we appeal a RAC automated audit that results in a denial?

Free Sample: RAC Tracking Spreadsheet

  • Recovery Auditor Report, Issue 16, August 6, 2009

    Have you developed a way to manage the complex task of tracking your RAC requests and appeals? If...

Answer and win! What do you know about the RAC Validation Contractor?

  • Recovery Auditor Report, Issue 16, August 6, 2009

    Having a strong knowledge of RACs (e.g., what to expect, timelines, how to appeal, etc.) is...

Medicaid Integrity Contractors: Coming to a hospital near you

  • Recovery Auditor Report, Issue 15, July 23, 2009

    Nearly 500 Medicaid audits are under way in 17 states, and the program will roll out to the entire...

Master wound care coding to prepare for RAC audits

  • Recovery Auditor Report, Issue 11, May 28, 2009

    Coders should arm themselves with as much wound care and coding knowledge as possible to prepare...

Revenue Cycle Institute releases new White Papers on Incident to and E/M auditing

  • Recovery Auditor Report, Issue 9, April 30, 2009

    The HCPro Revenue Cycle Institute has just released two new complimentary White Papers.

Tip: Ask the right questions to ensure an effective admissions review program

  • Recovery Auditor Report, Issue 8, April 16, 2009

    Are you certain your admissions review program is as effective as it needs to be so you can avoid...

Understand diagnosis coding to protect against auditor scrutiny

  • Recovery Auditor Report, Issue 4, February 19, 2009

    When coding for outpatient procedures, coders should base the patient’s diagnosis on his or...

CMS RAC Open Door forum update

  • Recovery Auditor Report, Issue 7, November 13, 2008

    CMS will be holding a special RAC Open Door Forum for Part B providers Thursday, November 13, at...

Update: CMS delays RAC permanent program

  • Recovery Auditor Report, Issue 7, November 13, 2008

    By now you know that CMS announced a delay in the Medicare RAC permanent program. But what you may...

In the news: SSA seeks input on increasing efficiency of ALJ hearings

  • Recovery Auditor Report, Issue 7, November 13, 2008

    The Social Security Administration is seeking comments on a proposed rule that will attempt to...