Revenue Cycle Articles by Topic: Medicare Coverage and Reimbursement
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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC Report, Issue 22, October 29, 2009
There’s no question that audit activity is escalating and the healthcare provider community...
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The RAC 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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The RAC Report, Issue 21, October 15, 2009
HealthDataInsights (HDI) has announced two new issues for region D.
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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC Report, Issue 21, October 15, 2009
The Revenue Cycle Institute has released a new White Paper, “Inpatient or Outpatient Only...
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The RAC 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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The RAC 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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The RAC Report, Issue 20, October 1, 2009
On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...
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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC 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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Patient Access Weekly Advisor, Issue 36, September 9, 2009
Might there be a little friendly competition between RACs and MACs?
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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC 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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The RAC Report, Issue 18, September 3, 2009
CMS updated the three RAC FAQ on August 26.
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The RAC 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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The RAC 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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The RAC 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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The RAC Report, Issue 17, August 20, 2009
On August 7, CMS issued transmittal R1793CP to modify one aspect of the logic that the Part A...
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The RAC 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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HCPRO Website, Issue 1, August 13, 2009
HealthDataInsights, Inc. (HDI), launched its new RAC Web site, and posted the first set of issues...
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The RAC Report, Issue 16, August 6, 2009
Q: Can we appeal a RAC automated audit that results in a denial?
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The RAC 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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The RAC Report, Issue 15, July 23, 2009
CMS is often asked about other claim types that may be affected by a full inpatient denial and if...
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The RAC Report, Issue 15, July 23, 2009
The Revenue Cycle Institute has released a new white paper, “Present on Admission: Accurate...
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The RAC 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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The RAC Report, Issue 14, July 9, 2009
When it comes to surviving RACs, effective physician advisors can be a “saving grace,&rdquo...
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The RAC Report, Issue 14, July 9, 2009
Take advantage of a handy tool to ensure that your physicians don’t overlook Initial...
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The RAC Report, Issue 13, June 25, 2009
On June 12, CMS updated the Medicare Financial Management Manual with information pertaining to the...
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The RAC Report, Issue 13, June 25, 2009
One of the best ways to prepare for a RAC audit comes in learning from survivors. Elizabeth Lamkin...
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The RAC Report, Issue 13, June 25, 2009
Q. Our Midwestern physician practice that has more than 30 physicians. Are physician offices...
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The RAC Report, Issue 13, June 25, 2009
When planning for RAC record requests, HIM directors should ask several essential questions.
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The RAC Report, Issue 13, June 25, 2009
Q: If you submit requested medical records to RACs via CD, are you still reimbursed copying costs...
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The RAC Report, Issue 12, June 11, 2009
CMS released 14 new RAC FAQ June 3.
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The RAC Report, Issue 12, June 11, 2009
CMS anticipates RAC automated reviews will begin in late June and July, according to Marie Casey...
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The RAC Report, Issue 12, June 11, 2009
In the July 2009 quarterly updates, CMS revised portions of both the Claims Processing Manual and...
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The RAC Report, Issue 12, June 11, 2009
Help ensure your facility properly obtains ABNs from patients for Medicare noncovered services with...
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The RAC Report, Issue 11, May 28, 2009
CMS released four new and updated RAC FAQ on May 19. The FAQ range from the broad ("Why is CMS...
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The RAC Report, Issue 11, May 28, 2009
Q: If my hospital is not using the latest InterQual criteria, could that chart be pulled by the RAC...
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The RAC 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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The RAC Report, Issue 11, May 28, 2009
Q: Are the Medicare Advantage plans included in RAC audits?
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The RAC Report, Issue 11, May 28, 2009
We invite you to take our comprehensive survey on what your facility is doing to prepare for the...
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The RAC Report, Issue 10, May 14, 2009
The “Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role...
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The RAC Report, Issue 9, April 30, 2009
CMS has posted the recording, transcript and other related information from the April 8 RAC Open...
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The RAC Report, Issue 9, April 30, 2009
The American Hospital Association (AHA) has shared what it knows about RACs via a Member...
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The RAC Report, Issue 9, April 30, 2009
Q: We have been trying to calculate the outpatient hospital medical record request limits...
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The RAC Report, Issue 9, April 30, 2009
The HCPro Revenue Cycle Institute has just released two new complimentary White Papers.
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The RAC Report, Issue 9, April 30, 2009
Recordings of the following “Recovery Audit Contractor Defense: A RAC Readiness Summit&rdquo...
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The RAC Report, Issue 9, April 30, 2009
Are RACs violating CMS’ own rules? Palomar Medical Center in Escondido, CA believes they are.
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The RAC Report, Issue 8, April 16, 2009
CMS has updated its RAC education and outreach schedule. The schedule contains new information...
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The RAC 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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The RAC Report, Issue 8, April 16, 2009
According to CMS, as noted in the April 14 Medicare RAC Special Open Door Forum, the following are...
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The RAC Report, Issue 8, April 16, 2009
If you haven’t visited the Revenue Cycle Institute Web site recently, now is a good time. In...
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The RAC Report, Issue 7, April 2, 2009
CMS will be holding two Special Open Door Forums on RACs for Part A and Part B providers in April...
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The RAC Report, Issue 7, April 2, 2009
The HCPro Revenue Cycle Institute released a new White paper on injection and infusion coding and...
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The RAC Report, Issue 7, April 2, 2009
Q: How will the RAC audits affect critical access hospitals (CAH) seeing as they are paid on a per...
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The RAC Report, Issue 7, April 2, 2009
CMS has recently announced the first round of provider information and outreach sessions on RACs...
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The RAC Report, Issue 7, April 2, 2009
If you’ve experienced RACs at your facility during the demonstration project, we want to hear...
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The RAC Report, Issue 7, April 2, 2009
Thanks to all who participated in our contest! In the previous issue of The RAC Report, we featured...
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The RAC Report, Issue 6, March 19, 2009
On March 6 CMS issued Transmittal 148 rescinding and replacing previous instruction regarding the...
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The RAC Report, Issue 6, March 19, 2009
Q: A provider does three different procedures in three different days. Is this acceptable? Are RACs...
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The RAC Report, Issue 6, March 19, 2009
Never assume that sepsis is present on admission (POA). Sepsis or severe sepsis may be present on...
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The RAC Report, Issue 6, March 19, 2009
Think you know everything there is to know about RACs? Test your knowledge and enter to win!
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The RAC Report, Issue 5, March 5, 2009
RACs cannot randomly select or target a claim “solely because it is a high-dollar...
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The RAC Report, Issue 5, March 5, 2009
Q: How does a RAC denial notice come into your system? Does it go to the CFO or CEO, or to the...
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The RAC Report, Issue 5, March 5, 2009
Find out the answers to the trivia questions we asked in the previous issue of The RAC Report.
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The RAC Report, Issue 4, February 19, 2009
Editor’s note: Answer all the questions correctly and submit your answer on or before...
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The RAC 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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The RAC Report, Issue 4, February 19, 2009
The announcement from CMS officially kicks the RAC program back into gear. Hospitals and providers...
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The RAC Report, Issue 4, February 19, 2009
CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...
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Patient Access Weekly Advisor, Issue 5, February 11, 2009
Use these Medicare Secondary Payer tips in order to remain compliant and obtain full reimbursement.
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HCPRO Website, Issue 4, February 6, 2009
CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...
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The RAC Report, Issue 3, February 5, 2009
It is no secret that RACs focused on one-day stays in the demonstration project. So what are you...
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The RAC Report, Issue 3, February 5, 2009
Most inpatient coders are accustomed to seeing “probable,” “suspected,&rdquo...
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The RAC Report, Issue 3, February 5, 2009
We’ve added several new features to our Revenue Cycle Institute Web site...
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Patient Access Weekly Advisor, Issue 4, February 3, 2009
Mandatory use of the new ABN form will be here before you know it.
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The RAC Report, Issue 2, January 22, 2009
Medical necessity is complex because there is debate regarding what constitutes...
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The RAC Report, Issue 2, January 22, 2009
Consider the following 10 RAC facts as you prepare for RACs to go live in your area.
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Patient Access Weekly Advisor, Issue 2, January 21, 2009
Inauguration speeches are all about promises. Dunn Memorial Hospital’s patient access team...
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The RAC Report, Issue 11, January 8, 2009
On January 6 CMS released an update to its three-year RAC demonstration program report previously...
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The RAC Report, Issue 10, December 24, 2008
Although coding denials did not remain the focus by the end of the demonstration project, and...
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The RAC Report, Issue 10, December 24, 2008
By Barbara Aubry, RN, CPC, CHCQM, FAIHQ
As mentioned in the previous issue of the RAC Report...
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The RAC Report, Issue 10, December 24, 2008
Are you questioning a claim reviewed by a RAC during the demonstration project? If so, CMS...
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The RAC Report, Issue 9, December 11, 2008
CMS posted new and updated RAC FAQs on the CMS Web site on December 2.
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The RAC Report, Issue 9, December 11, 2008
If documentation in the medical record is not accurate, complete and timely patient care can be...
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The RAC Report, Issue 9, December 11, 2008
In Transmittal 144, released November 28, CMS revised its Monthly Statistical Report on...
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Patient Access Weekly Advisor, Issue 78, November 26, 2008
CMS tweaked its transmittal updating the Medicare deductible, coinsurance, and premium rates for...
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Patient Access Weekly Advisor, Issue 77, November 19, 2008
Revenue cycle managers must continue to prepare their staff members to help confused patients with...
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The RAC 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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The RAC Report, Issue 7, November 13, 2008
The Social Security Administration is seeking comments on a proposed rule that will attempt to...
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The RAC Report, Issue 6, October 30, 2008
Question: Under what circumstances can a RAC make a finding that an overpayment or underpayment...
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Patient Access Weekly Advisor, Issue 71, October 8, 2008
Federal regulators are investigating charges to Medicare in the Miami area, where government costs...
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Patient Access Weekly Advisor, Issue 69, September 24, 2008
Check out these MSP tips provided by Stephanie Smithson, CHAM, patient access manager at Dunn...