Revenue Cycle Articles by Topic: Auditing
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Recovery Auditor Report, Issue 24, November 29, 2012
On November 15, the OIG issued a review of ALJ appeals decided in fiscal year 2010.
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Recovery Auditor Report, Issue 24, November 29, 2012
CMS issues notice on hospital outpatient payment panel
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Recovery Auditor Report, Issue 23, November 15, 2012
On October 16, it was reported that legislation was introduced by Representative Sam Graves (R-MO...
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Recovery Auditor Report, Issue 23, November 15, 2012
HealthDataInsights posts four new issues across two categories
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Medicare Update for CAHs, Issue 23, November 14, 2012
HealthDataInsights posts two new issues for outpatient hospital claims
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Recovery Auditor Report, Issue 22, November 1, 2012
Representative Sam Graves (R-MO) introduced legislation October 16 that aims to improve the...
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Recovery Auditor Report, Issue 22, November 1, 2012
Performant Recovery posts three issues across two categories
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Recovery Auditor Report, Issue 21, October 18, 2012
HealthDataInsights posts two new issues across two categories, including first prepayment review...
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Medicare Update for CAHs, Issue 21, October 17, 2012
HealthDataInsights posts two new issues across two categories, including first prepayment review...
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Recovery Auditor Report, Issue 20, October 4, 2012
HCPro and the Revenue Cycle Institute team are proud to announce the 2012 Medicare Compliance Forum
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Recovery Auditor Report, Issue 20, October 4, 2012
Following the close of each fiscal year (FY) quarter, CMS releases statistics for the amount of...
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Recovery Auditor Report, Issue 20, October 4, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 19, September 20, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 19, September 20, 2012
DCS Healthcare posts new issue for inpatient hospital claims
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Recovery Auditor Report, Issue 18, September 6, 2012
DCS Healthcare posts new issue for outpatient hospital claims
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Recovery Auditor Report, Issue 18, September 6, 2012
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
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Medicare Update for CAHs, Issue 18, September 5, 2012
Following the announcement of the official start date of prepayment reviews (set to begin August...
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Medicare Update for CAHs, Issue 18, September 5, 2012
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
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Recovery Auditor Report, Issue 17, August 23, 2012
Connolly posts 10 new issues across three categories
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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...
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Recovery Auditor Report, Issue 15, August 9, 2012
CMS officially announced the Recovery Auditor prepayment review demonstration this past November...
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Recovery Auditor Report, Issue 14, August 9, 2012
DCS Healthcare posts seven new issues across four categories
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Medicare Update for CAHs, Issue 16, August 8, 2012
DCS Healthcare posts new issue for DME claims
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Recovery Auditor Report, Issue 14, July 26, 2012
CGI posts four new issues for physician claims
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Medicare Update for CAHs, Issue 15, July 25, 2012
CGI posts four new issues for physician claims
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Recovery Auditor Report, Issue 13, July 12, 2012
CGI posts new issue for outpatient claims
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Medicare Update for CAHs, Issue 14, July 11, 2012
CMS instructs on provider self audits
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Medicare Update for CAHs, Issue 14, July 11, 2012
CGI posts new issue for outpatient claims
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Recovery Auditor Report, Issue 12, June 28, 2012
Last November, CMS unveiled three demonstration projects aimed at reducing improper payments in the...
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Recovery Auditor Report, Issue 12, June 28, 2012
HealthDataInsights posts seven new issues across three categories
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Medicare Update for CAHs, Issue 12, June 27, 2012
HealthDataInsights posts seven new issues across three categories
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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...
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Recovery Auditor Report, Issue 11, June 14, 2012
DCS Healthcare posts ten new issues across six categories
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Recovery Auditor Report, Issue 10, May 31, 2012
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.
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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...
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Medicare Update for CAHs, Issue 11, May 30, 2012
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.
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Patient Access Weekly Advisor, Issue 20, May 23, 2012
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter...
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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...
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Recovery Auditor Report, Issue 9, May 17, 2012
DCS Healthcare posts one new issue into two categories
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Medicare Update for CAHs, Issue 10, May 16, 2012
DCS Healthcare posts one new issue into two categories
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Recovery Auditor Report, Issue 7, April 19, 2012
On March 20, the Office of Inspector General (OIG) issued a report that presents an early...
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Recovery Auditor Report, Issue 7, April 19, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 7, April 19, 2012
DCS Healthcare posts eight new issues across four categories
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Medicare Update for CAHs, Issue 8, April 18, 2012
DCS Healthcare posts two new issues for skilled nursing facility claims
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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...
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Recovery Auditor Report, Issue 6, April 5, 2012
In early March, CMS released two related transmittals that rescinded prior transmittals.
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Recovery Auditor Report, Issue 6, April 5, 2012
DCS Healthcare posts three new issues across two categories
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Medicare Update for CAHs, Issue 7, April 4, 2012
CMS redesigns claims and benefits statement
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Medicare Update for CAHs, Issue 7, April 4, 2012
After reading about another provider’s Recovery Auditor correspondence woes in a February 23...
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Medicare Update for CAHs, Issue 7, April 4, 2012
DCS Healthcare posts new issue for medical necessity claims
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Recovery Auditor Report, Issue 5, March 22, 2012
On March 12, CMS issued an update that effectively raises the additional documentation requests...
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Recovery Auditor Report, Issue 5, March 22, 2012
After reading about another provider’s Recovery Auditor correspondence woes in a February 23...
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Medicare Update for CAHs, Issue 6, March 21, 2012
CMS recently released two replacement transmittals that summarize Recovery Auditor-identified...
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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...
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Recovery Auditor Report, Issue 4, March 8, 2012
What type of impact do you think the newly announced demonstration project for recovery auditor...
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Medicare Update for CAHs, Issue 5, March 7, 2012
HealthDataInsights posts seven new issues for medical necessity claims
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Recovery Auditor Report, Issue 3, February 23, 2012
On February 9, CMS posted its latest recovery auditor update. The results show a continuing trend...
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Recovery Auditor Report, Issue 3, February 23, 2012
DCS Healthcare posts new issue for DME supplier claims
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Medicare Update for CAHs, Issue 4, February 22, 2012
What type of impact do you think the newly announced demonstration project for recovery auditor...
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Recovery Auditor Report, Issue 3, February 9, 2012
Get answers to your questions and Medicare compliance guidance from the experts all year long.
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Recovery Auditor Report, Issue 3, February 9, 2012
On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...
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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...
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Recovery Auditor Report, Issue 3, February 9, 2012
Connolly adds 17 new issues across five categories
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Medicare Update for CAHs, Issue 3, February 8, 2012
HealthDataInsights posts 33 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 3, February 8, 2012
On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...
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Recovery Auditor Report, Issue 2, January 26, 2012
Each quarter CMS issues a recovery audit program update that details the total amount of...
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Recovery Auditor Report, Issue 2, January 26, 2012
In its most recent (January 20) Medicare Quarterly Provider Compliance Newsletter, CMS once again...
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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...
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Recovery Auditor Report, Issue 2, January 26, 2012
DCS Healthcare posts 25 new issues for medical necessity claims
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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...
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Medicare Update for CAHs, Issue 2, January 25, 2012
DCS Healthcare posts 25 new issues for medical necessity claims
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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...
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Recovery Auditor Report, Issue 1, January 12, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 1, January 12, 2012
DCS Healthcare posts 40 new issues for medical necessity claims
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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...
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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...
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Medicare Update for CAHs, Issue 2, January 11, 2012
DCS Healthcare posts 54 new issues across two categories
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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...
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Recovery Auditor Report, Issue 26, December 29, 2011
DCS Healthcare posts 45 new issues across two categories
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Medicare Update for CAHs, Issue 14, December 28, 2011
Time limit for filing an appeal after:
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Recovery Auditor Report, Issue 25, December 15, 2011
Be part of a comprehensive assessment of the recovery auditor program and learn how facilities...
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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...
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Recovery Auditor Report, Issue 25, December 15, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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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...
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Recovery Auditor Report, Issue 24, December 1, 2011
DCS Healthcare posts 66 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 12, November 30, 2011
When the 2012 outpatient prospective payment system (OPPS) proposed rule was released, there were a...
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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...
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Medicare Update for CAHs, Issue 12, November 30, 2011
DCS Healthcare posts 66 new issues for medical necessity claims
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Recovery Auditor Report, Issue 23, November 17, 2011
As part of the ongoing effort to reduce improper payments in Medicare and Medicaid, CMS announced...
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Recovery Auditor Report, Issue 23, November 17, 2011
DCS Healthcare posts 36 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 11, November 16, 2011
CMS issued the initial release of the second volume of Medicare Quarterly Compliance Newsletters...
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Medicare Update for CAHs, Issue 11, November 16, 2011
DCS Healthcare posts 36 new issues for medical necessity claims
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Recovery Auditor Report, Issue 22, November 3, 2011
CMS issued the initial release of the second volume of Medicare Quarterly Compliance Newsletters...
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Recovery Auditor Report, Issue 22, November 3, 2011
The American Hospital Association (AHA) will host four members-only conference calls—one for...
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Recovery Auditor Report, Issue 22, November 3, 2011
DCS Healthcare posts 20 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 10, November 2, 2011
DCS Healthcare adds 20 new issues for medical necessity claims
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Recovery Auditor Report, Issue 21, October 20, 2011
The following a checklist of best practice techniques when it comes to medical necessity and RAC...
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Recovery Auditor Report, Issue 21, October 20, 2011
CGI posts new issue for DME claims
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Recovery Auditor Report, Issue 21, October 20, 2011
RACs are auditing practices. Learn how to prepare.
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Medicare Update for CAHs, Issue 4, October 19, 2011
DCS Healthcare posts four new issues for medical necessity claims
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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...
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Recovery Auditor Report, Issue 20, October 6, 2011
While automated reviews do not require medical record (MR) review, they are the most difficult to...
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Recovery Auditor Report, Issue 20, October 6, 2011
DCS Healthcare posts four new issues for medical necessity claims
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Medicare Update for CAHs, Issue 8, October 5, 2011
CMS released a revised recovery audit contractor (RAC) statement of work (SOW) September 12 that...
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Medicare Update for CAHs, Issue 8, October 5, 2011
In February, the Centers for Medicare and Medicaid Services (CMS) delayed its expected April 1...
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Recovery Auditor Report, Issue 19, September 22, 2011
CGI posts new issue for professional claims
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Medicare Update for CAHs, Issue 7, September 21, 2011
Recent RAC activity
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Recovery Auditor Report, Issue 18, September 8, 2011
Editor’s note: This article was excerpted from the new HCPro book, “The RAC Toolkit for...
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Recovery Auditor Report, Issue 18, September 8, 2011
CGI posts new issue for professional claims
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Recovery Auditor Report, Issue 18, September 8, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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Medicare Update for CAHs, Issue 6, September 7, 2011
CMS instructs on ICD-10 billing, processing
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Medicare Update for CAHs, Issue 6, September 7, 2011
CGI posts new issue for professional claims
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Recovery Auditor Report, Issue 17, August 25, 2011
When you understand Medicare's rules and regulations you'll create a solid foundation to protect...
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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...
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Recovery Auditor Report, Issue 17, August 25, 2011
CGI posts three new issues across two categories
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Recovery Auditor Report, Issue 17, August 25, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Medicare Update for CAHs, Issue 5, August 24, 2011
Recovery audit contractors had previously been responsible for issuing demand letters to providers...
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Medicare Update for CAHs, Issue 5, August 24, 2011
CMS posts telemedicine survey letter
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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...
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Medicare Update for CAHs, Issue 5, August 24, 2011
CGI posts three new issues across two categories
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Recovery Auditor Report, Issue 16, August 11, 2011
Recovery audit contractors had previously been responsible for issuing demand letters to providers...
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Recovery Auditor Report, Issue 16, August 11, 2011
CMS has released a display copy of the IPPS final rule for fiscal year (FY) 2012.
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Recovery Auditor Report, Issue 16, August 11, 2011
DCS Healthcare posts two new issues for medical necessity claims
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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...
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Medicare Update for CAHs, Issue 4, August 10, 2011
DCS Healthcare posts six new issues for medical necessity claims in Maryland.
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Recovery Auditor Report, Issue 15, July 28, 2011
DCS Healthcare posts new issue for DME claims
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Recovery Auditor Report, Issue 15, July 28, 2011
RAC and other government auditor denials continue to mount up and it’s more important than...
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Medicare Update for CAHs, Issue 3, July 27, 2011
Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports became available to CAHs...
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Medicare Update for CAHs, Issue 3, July 27, 2011
Get answers to your questions and Medicare compliance guidance from the experts all year long.
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Recovery Auditor Report, Issue 14, July 14, 2011
DCS Healthcare posts two new issues for medical necessity claims
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Recovery Auditor Report, Issue 14, July 14, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 13, June 30, 2011
In an effort to provide helpful information to providers, CMS released a special edition MedLearn...
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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...
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Recovery Auditor Report, Issue 13, June 30, 2011
DCS Healthcare posts new issue for medical necessity claims
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Medicare Update for CAHs, Issue 1, June 29, 2011
Inpatient-only procedures are those that CMS determined may only be safely performed on an...
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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...
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Medicare Update for CAHs, Issue 1, June 29, 2011
Here is a summary of recovery audit contractor (RAC) activity from the past two weeks.
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Recovery Auditor Report, Issue 12, June 16, 2011
Editor’s note: This article is the third in a series of three IPPS-related updates.
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Recovery Auditor Report, Issue 12, June 16, 2011
This week CMS released a special edition MLN Matters article reviewing the coverage of percutaneous...
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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...
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Recovery Auditor Report, Issue 11, June 2, 2011
DCS Healthcare posts five new issues for medical necessity claims
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Recovery Auditor Report, Issue 10, May 19, 2011
On April 19, CMS released the inpatient prospective payment system proposed rule for 2012, which...
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Recovery Auditor Report, Issue 10, May 19, 2011
A representative from the Office of Clinical Standards and Quality suggested to the audience that...
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Recovery Auditor Report, Issue 10, May 19, 2011
Noridian Administrative Services LLC, Medicare administrative contractor (MAC) for Montana, North...
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Recovery Auditor Report, Issue 10, May 19, 2011
DCS Healthcare posts three new issues for medical necessity claims
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Recovery Auditor Report, Issue 9, May 5, 2011
CMS released a short but useful Recovery Audit Contractor (RAC) update on its website that reports...
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Recovery Auditor Report, Issue 9, May 5, 2011
CMS and the Medicare Learning Network (MLN) released the third Medicare Quarterly Provider...
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Recovery Auditor Report, Issue 9, May 5, 2011
On April 27, the physician regulatory issues team (PRIT) discussed the audit of infusion code...
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Recovery Auditor Report, Issue 9, May 5, 2011
The Revenue Cycle Institute has released a new white paper, “RAC Preparedness: Five Ideas for...
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Recovery Auditor Report, Issue 9, May 5, 2011
DCS Healthcare posts 23 new issues for medical necessity claims
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Recovery Auditor Report, Issue 8, April 21, 2011
While reviewing medical records as part of an additional documentation request, a RAC coordinator...
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Recovery Auditor Report, Issue 8, April 21, 2011
DCS Healthcare posts three new issues for medical necessity claims
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Recovery Auditor Report, Issue 7, April 7, 2011
Providers familiar with automated claims reviews and complex claims reviews by the recovery audit...
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Recovery Auditor Report, Issue 7, April 7, 2011
DCS Healthcare posts seven new issues for DRG validation claims
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Recovery Auditor Report, Issue 7, April 7, 2011
CMS’ Medicare Learning Network® has released the first in a series of podcasts designed...
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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...
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Recovery Auditor Report, Issue 6, March 24, 2011
A Government Accountability Office (GAO) study released March 9 identifies five ways in which GAO...
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Recovery Auditor Report, Issue 6, March 24, 2011
On March 9, CMS released a special edition MLN Matters article that highlights the importance of...
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Recovery Auditor Report, Issue 6, March 24, 2011
Pre-existing condition insurance plans
A representative from the Centers of Consumer Information...
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Recovery Auditor Report, Issue 6, March 24, 2011
Connolly posts six new RAC issues across six categories
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Recovery Auditor Report, Issue 5, March 10, 2011
On February 23, the American Hospital Association (AHA) issued a letter to CMS regarding the...
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Recovery Auditor Report, Issue 5, March 10, 2011
Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to...
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Recovery Auditor Report, Issue 5, March 10, 2011
CMS recently increased the number of medical records that recovery audit contractors (RAC) can...
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Recovery Auditor Report, Issue 5, March 10, 2011
DCS Healthcare posts 29 new issues across two categories
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Recovery Auditor Report, Issue 4, February 24, 2011
As it currently stands, providers respond to documentation requests from review contractors such as...
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Recovery Auditor Report, Issue 4, February 24, 2011
The Revenue Cycle Institute has released a new white paper, “Master the Intricacies of the...
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Recovery Auditor Report, Issue 4, February 24, 2011
CMS and the Medicare Learning Network (MLN) released the second Medicare Quarterly Provider...
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Recovery Auditor Report, Issue 4, February 24, 2011
As some expected, the expansion of Medicaid recovery audit contractors (RAC) is proving difficult.
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Recovery Auditor Report, Issue 4, February 24, 2011
In response to feedback from the RACs, physicians and their associations, CMS modified the...
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Recovery Auditor Report, Issue 3, February 10, 2011
This past summer when the first Recovery Audit Contractor (RAC) approved the issue “inpatient...
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Recovery Auditor Report, Issue 3, February 10, 2011
A CMS representative began the presentation portion of the call by talking about admissions...
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Recovery Auditor Report, Issue 3, February 10, 2011
CGI removes four DRG validations issues
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Recovery Auditor Report, Issue 3, February 10, 2011
Providers and payers alike have to stay on top of a regulatory environment that is constantly...
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Recovery Auditor Report, Issue 2, January 27, 2011
Name: Nancy J. Beckley, MS, MBA, CHC
Title: President
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Recovery Auditor Report, Issue 2, January 27, 2011
DCS Healthcare posts seven new issues for DRG validation claims
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Recovery Auditor Report, Issue 2, January 27, 2011
CMS has posted the following frequently asked question:
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Recovery Auditor Report, Issue 2, January 27, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 1, January 13, 2011
Name: Stacey Levitt, RN, MSN, CPC
Title: Senior Administrative Director of Patient Care...
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Recovery Auditor Report, Issue 1, January 13, 2011
HealthDataInsights adds four new issues for Part A inpatient claims review
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Recovery Auditor Report, Issue 1, January 13, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 1, January 13, 2011
Get answers to your questions and Medicare compliance guidance from the experts all year long. Join...
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Recovery Auditor Report, Issue 24, December 30, 2010
Name: William Malm, ND, RN
Title: Healthcare consultant
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Recovery Auditor Report, Issue 24, December 30, 2010
On December 20, the American Hospital Association (AHA) issued a letter to CMS containing comments...
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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...
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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.
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Recovery Auditor Report, Issue 24, December 30, 2010
HealthDataInsights adds two new issues across two categories
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Recovery Auditor Report, Issue 23, December 16, 2010
Continuing in its endeavor to publicize valuable information derived from the RAC demonstration...
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Recovery Auditor Report, Issue 23, December 16, 2010
Name: Yvonne Focke, RN, BSN, MBA
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Recovery Auditor Report, Issue 23, December 16, 2010
CMS released a transmittal on December 10 that will require that a mandatory advanced beneficiary...
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Recovery Auditor Report, Issue 23, December 16, 2010
The Revenue Cycle Institute has released a new white paper, “RAC Preparedness Benchmarking...
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Recovery Auditor Report, Issue 23, December 16, 2010
DCS Healthcare adds 23 issues across four categories
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Recovery Auditor Report, Issue 23, December 16, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 22, December 2, 2010
Name: Elizabeth Lamkin
Title: President
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Recovery Auditor Report, Issue 22, December 2, 2010
The Revenue Cycle Institute recently had a brief conversation with Karen Sagen, managed care leader...
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Recovery Auditor Report, Issue 22, December 2, 2010
On November 10, CMS-in response to feedback from the RACs, providers/suppliers and their...
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Recovery Auditor Report, Issue 22, December 2, 2010
CGI adds new RAC issue in two separate categories
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Recovery Auditor Report, Issue 21, November 11, 2010
CMS released the long-anticipated proposed rule for Medicaid recovery audit contractors (RACs...
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Recovery Auditor Report, Issue 21, November 11, 2010
Name: Nancy Hirschl, B.S., CCS
Title: President
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Recovery Auditor Report, Issue 21, November 11, 2010
Hospital quality update
A CMS representative informed the audience that the hospital-acquired...
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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...
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Recovery Auditor Report, Issue 20, October 28, 2010
On October 25, AHA News Now published information on a new CMS policy that prohibits Medicaid...
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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...
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Recovery Auditor Report, Issue 20, October 28, 2010
CGI adds new issue for DME claims
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Recovery Auditor Report, Issue 19, October 14, 2010
CMS and the Medicare Learning Network (MLN) recently released the Medicare Quarterly Provider...
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Recovery Auditor Report, Issue 19, October 14, 2010
Name: Donna Wilson, RHIA, CCS
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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...
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Recovery Auditor Report, Issue 19, October 14, 2010
As previously discussed, CMS has been laying groundwork for the expansion of RACs into Medicaid.
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Recovery Auditor Report, Issue 18, September 30, 2010
In an effort to propagate useful information on RAC high-dollar improper payment vulnerabilities...
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Recovery Auditor Report, Issue 18, September 30, 2010
After much anticipation, they’ve finally arrived. With the recent CMS approval of issues for...
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Recovery Auditor Report, Issue 18, September 30, 2010
DCS Healthcare posts new issue
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Recovery Auditor Report, Issue 18, September 30, 2010
Hospital quality update
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Recovery Auditor Report, Issue 18, September 30, 2010
The waiting is over. CMS has approved medical necessity RAC issues, creating a new challenge for...
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Recovery Auditor Report, Issue 17, September 16, 2010
CMS released through one of their provider listservs last week revised guidance on reporting the...
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Recovery Auditor Report, Issue 17, September 16, 2010
DCS Healthcare adds first medical necessity issues for review
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Recovery Auditor Report, Issue 17, September 16, 2010
Help us to understand your RAC experience.
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Recovery Auditor Report, Issue 17, September 16, 2010
Question: Are academic programs that practice more evidence-based medicine at a lower risk of audit...
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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...
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Recovery Auditor Report, Issue 16, September 2, 2010
Let’s face it; RACs are an albatross around the neck of susceptible providers.
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Recovery Auditor Report, Issue 16, September 2, 2010
According to a July HCPro survey of approximately 500 healthcare providers, 56% have already...
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Recovery Auditor Report, Issue 16, September 2, 2010
DCS Healthcare posts two new RAC issues
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Recovery Auditor Report, Issue 16, September 2, 2010
Diversified Collection Services (DCS) began its affiliation with the RAC program when CMS awarded...
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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...
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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...
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Recovery Auditor Report, Issue 15, August 19, 2010
Inpatient rehabilitation facilities (IRF) were the recent target of two OIG reviews.
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Recovery Auditor Report, Issue 15, August 19, 2010
DCS Healthcare posts 10 new RAC issues for non-medical necessity inpatient claims
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Recovery Auditor Report, Issue 15, August 19, 2010
A CMS representative informed the audience that the preview period for the September 2010 hospital...
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Recovery Auditor Report, Issue 15, August 19, 2010
On August 10, CMS released the final regulations that will fully implement improvements to the...
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Recovery Auditor Report, Issue 16, August 5, 2010
Recent approval of a Region C RAC issue for inpatient hospital claims review has initiated...
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Recovery Auditor Report, Issue 16, August 5, 2010
The provider community is reporting a new trend of late: RACs are denying post-discharge queries...
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Recovery Auditor Report, Issue 16, August 5, 2010
Connolly adds nine new RAC issues across three categories
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Recovery Auditor Report, Issue 16, August 5, 2010
CMS posts new RAC questions and answers
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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...
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Recovery Auditor Report, Issue 15, July 22, 2010
The Revenue Cycle Institute has become aware of published information that might be misleading or...
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Recovery Auditor Report, Issue 15, July 22, 2010
Each regional recovery audit contractor (RAC) differs in its approach when it comes to dealing with...
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Recovery Auditor Report, Issue 15, July 22, 2010
CGI adds three new RAC issues for DRG validation claims
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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...
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Recovery Auditor Report, Issue 14, July 8, 2010
Hospitals clamoring for guidance from CMS about the three-day payment window must now grapple with...
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Recovery Auditor Report, Issue 13, June 24, 2010
A recently released report titled “The Medicare RAC Program: Update to the evaluation of the...
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Recovery Auditor Report, Issue 13, June 24, 2010
DCS Healthcare posts 23 new RAC issues
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Recovery Auditor Report, Issue 13, June 24, 2010
In the increasingly stressful realm of RAC coordination the last thing providers need is additional...
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Recovery Auditor Report, Issue 13, June 24, 2010
DRG (diagnosis-related groups) validation issues have been the main target of RACs nationwide in...
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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...
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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...
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Recovery Auditor Report, Issue 12, June 10, 2010
With the growing number of CMS-approved RAC issues and the impending medical necessity audits on...
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Recovery Auditor Report, Issue 12, June 10, 2010
Be part of a comprehensive assessment of the Recovery Audit Contractor (RAC) program and how...
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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...
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Recovery Auditor Report, Issue 11, May 27, 2010
DCS Healthcare posts 3 new RAC issues for DRG validation review
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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...
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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...
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Recovery Auditor Report, Issue 11, May 27, 2010
A recently released transmittal from CMS adds direct language to the Medicare Program Integrity...
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Recovery Auditor Report, Issue 11, May 27, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 11, May 27, 2010
Be part of a comprehensive assessment of the Recovery Audit Contractor (RAC) program and how...
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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...
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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...
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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...
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Recovery Auditor Report, Issue 10, May 13, 2010
A recent transmittal released by CMS implemented a number of changes to the Medicare Financial...
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Recovery Auditor Report, Issue 10, May 13, 2010
CMS updates MAC business requirements regarding RACs
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Recovery Auditor Report, Issue 9, April 29, 2010
Connolly Healthcare posts 20 new RAC issues for non-medical necessity DRG validation reviews
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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...
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Recovery Auditor Report, Issue 9, April 29, 2010
Managing condition code 44 is complex; and knowing that the RACs will be looking at a...
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Recovery Auditor Report, Issue 9, April 29, 2010
A corporate compliance professional from a hospital in Indiana, who wished to remain anonymous...
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Recovery Auditor Report, Issue 9, April 29, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 8, April 15, 2010
CGI adds two new issues for medically unlikely edits (outpatient and professional)...
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Recovery Auditor Report, Issue 8, April 15, 2010
An anonymous reader shared with us their RAC experience, and had this to say:
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Recovery Auditor Report, Issue 8, April 15, 2010
According to a new Government Accountability Office (GAO) report, CMS has failed to take...
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Recovery Auditor Report, Issue 8, April 15, 2010
CMS announced a series of nationwide RAC 101 calls.
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Recovery Auditor Report, Issue 7, April 1, 2010
DCS Healthcare posts 3 new issues for DRG validation reviews
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Recovery Auditor Report, Issue 7, April 1, 2010
Since the implementation of the permanent RAC program, providers may not be taking full advantage...
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Recovery Auditor Report, Issue 7, April 1, 2010
CMS has published a useful chart detailing provider options for RAC overpayment determinations.
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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...
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Recovery Auditor Report, Issue 6, March 18, 2010
Connolly Healthcare added 25 RAC issues for non-medical necessity DRG validation reviews review to...
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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...
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Recovery Auditor Report, Issue 6, March 18, 2010
Although many providers have tried to curb undercoding over the years, the flurry of activity from...
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Recovery Auditor Report, Issue 6, March 18, 2010
A March 10 White House memorandum on finding and recapturing improper payments has mandated...
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Recovery Auditor Report, Issue 6, March 18, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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Recovery Auditor Report, Issue 5, March 4, 2010
Admission orders are an important area of focus for auditors charged with the responsibility for...
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Recovery Auditor Report, Issue 5, March 4, 2010
While RACs are not responsible for reviewing claims for potential fraud, they are responsible for...
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Recovery Auditor Report, Issue 5, March 4, 2010
During the demonstration project, RACs chose not to apply the process of extrapolation, and while...
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Recovery Auditor Report, Issue 5, March 4, 2010
CMS has notified notified the AHA that RACs have not been authorized to review all inpatient...
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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...
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Recovery Auditor Report, Issue 4, February 18, 2010
Connolly Healthcare, HealthDataInsights, CGI post new RAC issues.
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Recovery Auditor Report, Issue 4, February 18, 2010
By now providers nationwide are certainly familiar with Recovery Audit Contractors, or RACs. But...
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Recovery Auditor Report, Issue 4, February 18, 2010
In response to feedback from the RACs, providers, suppliers and their associations, CMS expanded...
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Recovery Auditor Report, Issue 4, February 18, 2010
As RACs begin to roll out complex reviews and request medical record documentation, compliant...
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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...
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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...
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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...
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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...
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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:
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Recovery Auditor Report, Issue 3, February 4, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 3, February 4, 2010
Has your organization undergone a Medicaid Integrity Contractor (MIC) audit? If so, we want to hear...
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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...
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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...
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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...
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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...
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Recovery Auditor Report, Issue 25, December 24, 2009
Requests for medical records are already arriving in hospital mailboxes following the approval of...
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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...
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Recovery Auditor Report, Issue 25, December 24, 2009
The medical record compilation process begins when the RAC makes a request, which must promptly...
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Recovery Auditor Report, Issue 25, December 24, 2009
Taking certain preventive measures can go a long way toward preparing your facility for RAC audits...
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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...
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Recovery Auditor Report, Issue 24, December 10, 2009
Connolly Healthcare has announced the first issues approved for complex RAC review, so providers in...
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Recovery Auditor Report, Issue 24, December 10, 2009
CMS has published new documentation request limits for RAC DRG validation audits in 2010. CMS...
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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...
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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...
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Recovery Auditor Report, Issue 24, December 10, 2009
The struggling economy has left many hospitals with thin wallets, and government auditors are...
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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...
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Recovery Auditor Report, Issue 24, November 25, 2009
Healthcare providers in several states received their first RAC denials. And Connolly Healthcare...
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Recovery Auditor Report, Issue 24, November 25, 2009
Budgets are tight, but it seems that many healthcare providers are aware that setting aside...
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Recovery Auditor Report, Issue 24, November 25, 2009
HealthDataInsights (HDI) has been approved by CMS to audit for inappropriate billing related to the...
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Recovery Auditor Report, Issue 24, November 25, 2009
Some of the issues CMS has already approved for review under the RAC permanent program are...
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Recovery Auditor Report, Issue 24, November 25, 2009
CMS released several new and updated FAQ on its Web site November 17.
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Recovery Auditor Report, Issue 24, November 25, 2009
CMS has contracted with the TMF Health Quality Institute to again release Program for Evaluating...
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Recovery Auditor Report, Issue 23, November 12, 2009
HealthDataInsights (HDI) has added multiple new RAC issues to their CMS-approved list in late...
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Recovery Auditor Report, Issue 23, November 12, 2009
Providers who believe their RAC denials will be limited to 200 every 45 days (corresponding with...
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Recovery Auditor Report, Issue 23, November 12, 2009
The Comprehensive Error Rate Testing (CERT) Hospital Payment Monitoring Program is one of the ways...
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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...
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Recovery Auditor Report, Issue 22, October 29, 2009
On October 15 CMS released an FAQ on the appearance of code N432 on remittance advice.
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Recovery Auditor Report, Issue 22, October 29, 2009
The high number of claims determinations appealed was a measure of dissatisfaction with the RAC...
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Recovery Auditor Report, Issue 22, October 29, 2009
St. Joseph Medical Center in Houston has been preparing for RACs for months now, says Cucharras...
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Recovery Auditor Report, Issue 22, October 29, 2009
There’s no question that audit activity is escalating and the healthcare provider community...
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Recovery Auditor Report, Issue 21, October 15, 2009
As of September 18, all four RACs were conducting automated audits, according to an October 6...
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Recovery Auditor Report, Issue 21, October 15, 2009
HealthDataInsights (HDI) has announced two new issues for region D.
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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...
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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...
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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...
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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...
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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...
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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...
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Recovery Auditor Report, Issue 20, October 1, 2009
CMS released the following new RAC FAQ September 25: How long is the Recovery Audit Contractor...
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Recovery Auditor Report, Issue 20, October 1, 2009
At this point, thanks to a three-year demonstration project and a plethora of available information...
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Recovery Auditor Report, Issue 20, October 1, 2009
The Revenue Cycle Institute has released a new White Paper, “Sepsis and Septicemia: Clear Up...
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Recovery Auditor Report, Issue 19, September 17, 2009
Connolly, the RAC for Region C, approved several issues for North Carolina providers on September...
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Recovery Auditor Report, Issue 19, September 17, 2009
Q: Several RACs are looking for once in a lifetime procedure coding errors. Wouldn’t...
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Recovery Auditor Report, Issue 19, September 17, 2009
CMS released on September 11 transmittal 302, which outlines the authority RACs, MACs, and other...
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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...
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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...
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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...
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Recovery Auditor Report, Issue 18, September 3, 2009
Connolly, the Region C RAC, has been approved to audit Durable Medical Equipment (DME) providers...
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Recovery Auditor Report, Issue 18, September 3, 2009
Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida, including...
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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...
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Recovery Auditor Report, Issue 18, September 3, 2009
CMS updated the three RAC FAQ on August 26.
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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...
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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...
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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...
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Recovery Auditor Report, Issue 17, August 20, 2009
HealthDataInsights, Inc. (HDI), launched its new RAC Web site, and posted the first set of issues...
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Recovery Auditor Report, Issue 17, August 20, 2009
Connolly and HealthDataInsights (HDI) have released their first set of “approved...
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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.
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Recovery Auditor Report, Issue 16, August 6, 2009
Heads up, healthcare providers: Connolly Healthcare, the RAC for Region C, has posted the first set...
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Recovery Auditor Report, Issue 16, August 6, 2009
For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal...
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Recovery Auditor Report, Issue 16, August 6, 2009
Q: Can we appeal a RAC automated audit that results in a denial?
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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...
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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...
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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...
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Recovery Auditor Report, Issue 11, May 28, 2009
Coders should arm themselves with as much wound care and coding knowledge as possible to prepare...
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Recovery Auditor Report, Issue 9, April 30, 2009
The HCPro Revenue Cycle Institute has just released two new complimentary White Papers.
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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...
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Recovery Auditor Report, Issue 4, February 19, 2009
When coding for outpatient procedures, coders should base the patient’s diagnosis on his or...
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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...
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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...
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Recovery Auditor Report, Issue 7, November 13, 2008
The Social Security Administration is seeking comments on a proposed rule that will attempt to...
