Revenue Cycle

Revenue Cycle Articles by Topic: Medicare Coverage and Reimbursement

HCPro Watchdog Service

  • HCPRO Website, Issue 20, March 5, 2013

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

Recent Recovery Auditor activity

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

    Connolly posts 24 new issues across five categories

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

Focus on CAHs: 2013 OIG Work Plan

  • Medicare Update for CAHs, Issue 24, November 28, 2012

    The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS...

Important Medicare updates

  • Medicare Update for CAHs, Issue 24, November 28, 2012

    CMS issues press release on ACA impact on payments to primary care physicians

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...

Revenue Cycle Institute posts free monthly tool

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

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

Recent Recovery Auditor Activity

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

    HealthDataInsights posts four new issues across two categories

Final OPPS rule increases drug payments

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

    The 2013 Outpatient Prospective Payment System final rule finalizes ambulatory payment...

A clarification on billing for CAH swing bed services

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

    Editors note: This article was written by Debbie Mackaman, RHIA, CHCO, regulatory specialist for...

Prepayment review demonstration begins; CDI role in audit defense gains momentum

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

    Editor’s note: This article originally appeared in the CDI Journal.

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  

Readmissions Reduction: A 360-Degree Review

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

    Hospital readmissions have the potential to cause a negative financial impact on your facility and...

Important Medicare updates

  • Medicare Update for CAHs, Issue 22, October 31, 2012

    CMS issues press release on 2013 quality ratings for Medicare health and drug plans

True or false quiz: Billing for CT scan during a swing bed stay

  • Medicare Update for CAHs, Issue 22, October 31, 2012

    Normal 0 false false false EN-US X-NONE X-NONE...

New! Revenue Cycle Institute releases 2012 Principal Diagnosis White Paper

  • Medicare Insider, Issue 43, October 23, 2012

    The Revenue Cycle Institute has released a new white paper

CMS issues next wave of supervision decisions on Hospital Outpatient Payment Panel

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

    Earlier this year, CMS held its first Hospital Outpatient Payment Panel meeting, which managed to...

HHS Secretary Kathleen Sebelius interview with BC Advantage

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

    BC Advantage—a company that provides medical office with in-depth content written by industry...

Revenue Cycle Institute posts free monthly tool

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

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

Recent Recovery Auditor activity

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

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

Important Medicare Updates

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

    CMS issues preliminary decisions on recommendations of outpatient payment panel on supervision...

Quiz: Billing for an emergency room visit with extensive nursing care

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

    A Medicare beneficiary was seen in the hospital emergency department and required extensive nursing...

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

Recent Recovery Auditor activity

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

    DCS issues important provider notice

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.

CMS policies and conversion from ICD-9 to ICD-10

  • Medicare Update for CAHs, Issue 20, October 3, 2012

    It was a rather quiet week last week as CMS and the Medicare contractors, including providers, get...

Important Medicare updates

  • Medicare Update for CAHs, Issue 20, October 3, 2012

    CMS issues press release on Affordable Care Act

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

CAH perspective: CMS' proposal to redefine inpatient

  • Medicare Update for CAHs, Issue 19, September 19, 2012

    Editor’s note: On August 23, HCPro released an article that outlines a request that CMS made...

Important Medicare updates

  • Medicare Update for CAHs, Issue 19, September 18, 2012

    CMS issues administrative simplification final rule

Medicare Compliance Forum 2012 spotlight: CMS' proposal to redefine inpatient

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

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

Recent Recovery Auditor activity

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

    DCS Healthcare posts new issue for outpatient hospital claims

CMS releases October OPPS update

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

    CMS released the October OPPS update this week with a smattering of unrelated, but important...

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...

Important Medicare updates

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

    CMS announces Stage 2 final rule for Medicare and Medicaid EHR Incentive Programs

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

Financial impacts of the Hospital Readmissions Reduction Program

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

    Last week, Kimberly posted an overview of the FY 2013 IPPS final rule and the potential impact to a...

CMS issues payment methodology for global surgical split care submitted with Modifier -54 and/or -55 for CAH Method II providers

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

    On August 3, CMS issued a transmittal and accompanying MLN Matters article that providers...

Important Medicare Updates

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

    CMS issues interim final rule for healthcare EFT and RA transactions

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...

CMS releases 2013 IPPS final rule

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

    On August 1, CMS issued a display copy of the 2013 inpatient prospective payment system final rule.

Revenue Cycle Institute posts free monthly tool

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

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

Recent Recovery Auditor activity

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

    DCS Healthcare posts seven new issues across four categories

Physician supervision enforcement for CAHs: Part 2

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

    In addition to proposing to extend the non-enforcement of supervision rules for critical access...

Important Medicare updates

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

    CMS announces two website redesigns

Free tool: Level of care pocket card: Outpatient surgery and observation

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

    Download this pocket card to use as a helpful tool that provides important “points to...

Recent Recovery Auditor activity

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

    DCS Healthcare posts new issue for DME claims

Revenue Cycle Institute posts free monthly tool

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

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

Physician supervision enforcement for CAHs: Part 1

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

    On July 6, CMS released a display copy of the 2013 OPPS proposed rule.

CMS proposes two significant changes for OPPS in 2013

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

    CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6.

Recent Recovery Auditor activity

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

    CGI posts four new issues for physician claims

Important Medicare updates

  • Medicare Update for CAHs, Issue 15, July 24, 2012

    CMS issues three-day payment window FAQs

CMS issues 2013 OPPS proposed rule

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

    CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS...

CMS replaces transmittal on reporting of recoupment for overpayment on the RA

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

    On June 28, CMS replaced transmittal R1088OTN, containing information on the reporting of...

Recent Recovery Auditor activity

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

    CGI posts new issue for outpatient claims

Recovery auditor prepayment reviews: CAH impact and more

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

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

Important Medicare updates

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

    CMS instructs on provider self audits

Scenario: CAH staffing requirements

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

    Dr. Anderson is a physician that covers the emergency department of a critical access hospital...

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...

July OPPS update: Self-administered drugs

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

    Last week, Kimberly provided an overview of the many significant updates and clarifications that...

Revenue Cycle Institute posts free monthly tool

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

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

Recent Recovery Auditor activity

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

    HealthDataInsights posts seven new issues across three categories

July OPPS update: Self-administered drugs

  • Medicare Update for CAHs, Issue 13, June 27, 2012

    Last week, the Medicare Weekly Update provided an overview of the many significant updates and...

Scenario: Lab test coverage

  • Medicare Update for CAHs, Issue 13, June 27, 2012

    A physician ordered a bacterial urine culture (87086) for a Medicare patient from the...

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...

First of 2012: CMS announces supervision decisions for select services

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

    In the 2012 outpatient prospective payment system (OPPS) final rule, CMS established a process to...

Recent Recovery Auditor Activity

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

    DCS Healthcare posts ten new issues across six categories

Note from the instructor: July 2012 quarterly update contains multiple significant updates and clarifications

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

    There were a number of interesting items in the July 2012 Update to the Hospital Outpatient...

First of 2012: CMS announces supervision decisions for select services

  • Patient Access Weekly Advisor, Issue 23, June 13, 2012

    In the 2012 outpatient prospective payment system (OPPS) final rule, CMS established a process to...

CMS announces supervision levels for select services

  • Patient Access Weekly Advisor, Issue 22, June 6, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

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 revises Medicare Conditions of Participation for hospitals and CAHs

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

    On May 9, CMS released two rules aimed at reducing regulatory burdens for healthcare providers.

Important Medicare Updates

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

    CMS releases 2013 IPPS proposed rule

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

CMS instructs on payment methodology for anesthesiology claims submitted with a -GC modifier

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

    On April 26, CMS issued transmittal R2452CP that implements the payment methodology for...

Important Medicare updates

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

    CMS issues guidance on determining rural location for swing bed and RHC eligibility

Scenario: Billing for a Medicare patient's hernia repair

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

    Situation: Jonathan, a 68-year-old Medicare patient, presents to a hospital’s outpatient...

Recent Recovery Auditor Activity

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

    DCS Healthcare posts one new issue into two categories

CMS issues IPPS proposed rule for FY2013

  • Recovery Auditor Report, Issue 8, May 3, 2012

    Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year...

2012 broadcast events program calendar

  • Recovery Auditor Report, Issue 8, May 3, 2012

    Take a look at all of the different programs that HCPro has to offer this year in its 2012...

Heads up: Contractors holding Method II 85X claims with modifier -22

  • Medicare Update for CAHs, Issue 9, May 2, 2012

    On April 19, CMS sent out an e-mail notification regarding critical access hospitals (CAHs) that...

Important Medicare updates

  • Medicare Update for CAHs, Issue 9, May 2, 2012

    CMS continues updates to Program Integrity Manual

Scenario: Billing diagnostic services on a swing bed claim

  • Medicare Update for CAHs, Issue 9, May 2, 2012

    A patient was in a covered CAH swing bed stay receiving skilled nursing services for complications...

Recent Recovery Auditor Activity

  • Medicare Update for CAHs, Issue 9, May 2, 2012

    DCS Healthcare posts nine new issues across four categories

New! Revenue Cycle Institute releases 2012 Three-Day Rule White Paper

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

    The Revenue Cycle Institute has released a new white paper, “Mastering the Three-Day Payment...

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.

One-year delay of ICD-10-CM/PCS proposed from HHS

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

    HHS released a proposed rule yesterday that announces a one-year delay for the implementation of...

Recent Recovery Auditor activity

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

    DCS Healthcare posts eight new issues across four categories

CMS system update to allow correct NPI reporting for PCIP for CAHs reimbursed under optional method

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

    Earlier this year CMS released a transmittal that implements a system update to include the...

Important Medicare updates

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

    CMS revises "incident to" transmittal

Scenario: Calculating a patient's coinsurance amount at a Method I CAH

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

    Question: If a hospital charges $1,000 for an outpatient procedure and the cost of the procedure...

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 to resolve incorrect claims processing issue for 12X and 13X bill types

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

    On February 24, CMS sent out an update informing providers that it has identified a Medicare claims...

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 auditor hot topics: Medicaid RACs

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

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

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...

Revenue Cycle Institute posts free monthly tool

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

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

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...

Important Medicare updates

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

    OIG posts review of Medicare outpatient billing for selected drugs at NorthBay Medical Center (CA)

Scenario: Benefit period for a hospital/SNF patient stay

  • Medicare Update for CAHs, Issue 2, March 21, 2012

    Question: A Medicare beneficiary who had never before been hospitalized was admitted to and stayed...

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...

CMS issues guidance on place of service coding instructions

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

    On February 3, CMS issued a transmittal that revises and clarifies the national policy for place of...

Important Medicare updates

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

    HHS announces intent to delay ICD-10 compliance date

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...

Important Medicare updates

  • Medicare Update for CAHs, Issue 2, February 22, 2012

    CMS corrects 2012 payment rate increases for RHCs and FQHCs

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

MPPR to apply for certain diagnostic imaging procedures for Method II CAHs

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

    On January 26, CMS issued a transmittal that implements the multiple procedure payment reduction...

Important Medicare updates

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

    CMS allows physician assistants to perform SNF level of care certifications

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...

Peeling away the confusion: Split billing guidance

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

    The concept of split billing in both the inpatient and outpatient setting is a hot topic amongst...

Important Medicare updates

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

    CMS updates NCDs CMS posted a new version of the lab NCD manual for the first quarter  

Recent RAC activity

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

    DCS Healthcare posts 25 new issues for medical necessity claims

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

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

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

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 announces RHC and FQHC payment rate increases for 2012

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

    In early November, CMS issued a transmittal that provides the payment rate increases for rural...

Important Medicare updates

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

    CMS creates CO-OP program to expand health plans

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...

New! Revenue Cycle Institute releases 2011 Physician Supervision White Paper

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

    The Revenue Cycle Institute has released a new white paper, “Physician Supervision: Analyzing...

November 22, 2011 Hospital & Hospital Quality Open Door Forum Summary

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

    Hospital and CAH conditions of participation proposed rule

Recent RAC activity

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

    DCS Healthcare posts 45 new issues across two categories

Critical access hospital roundup: Select highlights from 2011

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

    Since we launched our inaugural issue in June, the Medicare Update for CAHs ezine has covered a...

November 15 Rural Health Open Door Forum Summary

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

    A CMS representative came on the line to talk about the Medicare Shared Savings Program final rule...

Important Medicare updates

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

    CMS posts instructions for completing Hospital/CAH Database Worksheet

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...

Physician supervision clarification still causing confusion

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

    In the calendar year (CY) 2012 OPPS Final Rule, CMS once again amended the regulations for...

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...

CMS finalizes physician supervision proposals: Part II

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

    When CMS finalized its physician supervision proposals in the 2012 outpatient prospective payment...

Important Medicare updates

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

    CMS revises the Interpretive Guidelines for hospitals and CAHs

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...

Revenue Cycle Institute posts free monthly tool

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

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

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...

Important Medicare updates

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

    DMEPOS Fee Schedule update

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...

CMS posts OPPS final rule display copy, press release, and fact sheet

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

    Last week, HCPro issued a breaking news story about the 2012 OPPS final rule, which applies to...

Recent RAC activity

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

    DCS Healthcare posts 36 new issues for medical necessity claims

CMS implements multiple procedure payment reduction policy for Method II CAHs

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

    On October 28, CMS issued a transmittal that implements the multiple procedure payment reduction...

CMS Rural Health Open Door Forum Summary: October 18, 2011

  • Medicare Update for CAHs, Issue 2, November 16, 2011

    A CMS representative came on the line to give an update about the revalidation effort that is...

Important Medicare updates

  • Medicare Update for CAHs, Issue 3, November 16, 2011

    CMS issues ACO final rule

Three strategies of financially successful CAHs

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

    By definition critical access hospitals are isolated. But just because they're isolated...

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

Revenue Cycle Institute posts free monthly tool

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

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

CAH impact: Proposed Medicare Conditions of Participation changes

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

    On Monday, October 24, CMS issued in the Federal Register a proposed rule that would revise the...

Important Medicare updates

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

    OIG reviews Medicare outpatient billing for selected drugs at Central Peninsula General Hospital

Tip: Billing for services while a patient is unstable

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

    Consider this scenario: A Medicare patient is brought the emergency department with a diagnosis of...

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.

CAHs take note: CMS issues additional self-administered drug guidance

  • Medicare Update for CAHs, Issue 9, October 19, 2011

    As a general rule, critical access hospitals as well as PPS hospitals across the country seem to...

Important Medicare updates

  • Medicare Update for CAHs, Issue 9, October 19, 2011

    OIG proposes to revise MFCU performance standards

Tip: Billing for hernia repair

  • Medicare Update for CAHs, Issue 9, October 19, 2011

    Consider this scenario: A Medicare patient presents to the outpatient surgery department for a...

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...

Changes in ambulance billing rules for CAHs

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

    This past August, CMS published in the Federal Register the 2012 inpatient prospective payment...

Important Medicare updates

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

    CMS released several MLN Matters articles related to previously-released transmittals.

Tip: Billing for PET scans during an unrelated inpatient stay

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

    A patient is admitted to the hospital for care of a heart attack and the patient’s oncologist...

New! Revenue Cycle Institute releases Principal Diagnosis Selection White Paper

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

    The Revenue Cycle Institute has released a new white paper, “Principal Diagnosis Selection...

Recent RAC activity

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

    CGI posts new issue for professional claims

CAHs and condition code 44

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

    The October 2011 update of the hospital outpatient prospective payment system (OPPS) contains a bit...

Important Medicare updates

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

    CMS bundled payments initiative On September 2, HCPro released an article summarizing CMS&rsquo...

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

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...

CAH impact: CMS telemedicine survey letter

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

    CMS has issued a survey and certification letter regarding telemedicine services in hospitals and...

Scenario: Appealing denied units when a service exceeds MUE limits

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

    Consider this example: On February 1, 2011, a hospital performed a lab test that is paid under the...

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.

CMS clarifies Method II CAH billing for anesthesiologist services

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

    On August 1, CMS issued a transmittal that clarifies payment calculations for anesthesia services...

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...

Tip: ABN form scenario

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

    Consider this example: A Medicare patient receives a lab test for follow-up care related to his...

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...

Providers take note: CMS releases revised ABN form

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

    On a July 13 Hospital Open Door Forum call, CMS announced the release of its revised advanced...

Important Medicare updates

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

    CMS updates CLIA HCPCS list On July 22, CMS issued a transmittal to inform contractors of new...

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

CMS publishes OPPS proposed rule

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

    On July 18, CMS published in the Federal Register a proposed rule to modify the OPPS for calendar...

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...

Physician supervision requirements for critical access hospitals

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

    While the 2012 outpatient prospective payment system (OPPS) proposed rule may not contain many...

Important Medicare updates

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

    CMS updates lab NCDs CMS posted a new version of the lab NCD manual for the third...

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.

CMS releases 2012 OPPS proposed rule

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

    CMS released the 2012 outpatient prospective payment system (OPPS) proposed rule July 1.

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.

Changes to tracking observation hours and the CAH impact

  • Medicare Update for CAHs, Issue 2, July 13, 2011

    A change to Medicare Claims Processing Manual chapter 4 on “Reporting Hours of...

Important Medicare updates

  • Medicare Update for CAHs, Issue 2, July 13, 2011

    CMS issues OPPS proposed rule

Tip: Performing services at a separate facility

  • Medicare Update for CAHs, Issue 2, July 13, 2011

    If an employee of the critical access hospital performs a laboratory service at another facility...

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

June 1 Hospital & Hospital Quality Open Door Forum Summary

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

    A CMS representative gave the audience a reminder about the Section 1011 program, the federal...

New! Revenue Cycle Institute releases Medicare Annual Wellness Visit White Paper

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

    The Revenue Cycle Institute has released a new white paper, “Medicare’s Annual Wellness...

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...

Important Medicare updates

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

    CMS instructs on CAH optional method

Tip: Physician requirements for CAHs

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

    If there is a variance in the volume of patients being treated in the emergency department, a...

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...

CMS adjusts payment policy for replacement devices in IPPS proposed rule

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

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

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

Revenue Cycle Institute posts free monthly tool

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

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

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...

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...

Note: CMS publishes IPPS proposed rule for 2012

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

    On April 19, CMS put on display the proposed rule for IPPS services and other inpatient initiatives...

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

Revenue Cycle Institute posts free monthly tool

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

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

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...

Revenue Cycle Institute posts free monthly tool

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

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

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 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...

Inpatient-only procedures and the three-day rule

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

    CMS has clarified that outpatient procedures that meet preadmission packaging requirements and...

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...

CMS issues guidance on hospital inpatient admission decisions

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

    Medical necessity determinations are not just a hot button issue with RACs, but also with the other...

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.

Revenue Cycle Institute One-Question Poll

  • Recovery Auditor Report, Issue 2, January 26, 2011

    How likely would you be to utilize Twitter to follow Revenue Cycle Institute updates?  

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.

Clinical documentation improvement: Strengthen your program and protect against denials

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

    Hospitals are undoubtedly aware of how a quality clinical documentation improvement program can...

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

November 18, 2010 Hospital & Hospital Quality Open Door Forum Summary

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

    EHR Incentive program overview and update

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

Claim closed: How the demonstration can teach us about RAC-withdrawn reviews

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

    Nothing is ever easy for providers in the ever-fluctuating realm of RACs, and the latest spell of...

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  

Note: Special edition MLN Matters article on inpatient coding significantly revised

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

    In late September, CMS published an MLN Matters article entitled "Recovery Audit Contractor...

Recent RAC Activity

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

    DCS Healthcare posts new issue for DRG validation claims

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 releases additional documentation limits for FY 2011 for DME suppliers

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

    On October 19, CMS—in response to feedback from the RACs, providers/suppliers and their...

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...

OIG issues 2011 Work Plan

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

    Medical devices, radiation therapy quality and safety, and an expanded focus on the three- and...

Revenue Cycle Institute posts free monthly tool

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

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

Revenue Cycle Institute releases ICD-10 white paper

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

    The Revenue Cycle Institute has released a new white paper, “ICD-10-CM and ICD-10-PCS: Are...

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

CMS provides clarification to condition code 44 billing

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

    In the October 2010 update of the hospital outpatient prospective payment system (OPPS), CMS...

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...

Revenue Cycle Institute posts free monthly tool

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

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

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...

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

Revenue Cycle Institute releases Clinical Documentation Improvement white paper

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

    The Revenue Cycle Institute has released a new white paper, "What Every CDI Program Needs to...

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

Understand Medicare?s three-day payment window

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

    The three-day payment window rule (sometimes incorrectly referred to as the 72-hour rule) continues...

CMS posts 2011 IPPS final rule

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

    On July 30, CMS issued the inpatient prospective payment system (IPPS) final rule

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...

CMS issues proposals for new physician supervision requirements

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

    On July 2, CMS published the OPPS Proposed Rule for 2011 ahead of anticipated timeframes.

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...

Revenue Cycle Institute releases Critical Access Hospitals white paper

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

    The Revenue Cycle Institute has released a new white paper, “Critical Access Hospitals...

Revenue Cycle Institute posts free monthly tool

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

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

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...

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...

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...

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...

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

Watchdog advisory and monitoring services

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

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

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...

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...

Medicare Membership Program

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

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

Tips to help master medical necessity

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

    Having the right process—and people—in place can help ensure your hospital consistently...

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...

Senate health reform bill expands RAC program to Medicaid, Medicare Parts C and D

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

    Hold on to your stethoscopes, the Senate Healthcare Reform Bill is expanding the RAC program...

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...

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...

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...

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...

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...

Revenue Cycle Institute releases Observation white paper

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

    The Revenue Cycle Institute has released a new White Paper, “Inpatient or Outpatient Only...

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...

CMS clarifies RAC exception authority

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

    On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...

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...

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...

MACs vs. RACs: could competition mean more bad news for providers?

  • Patient Access Weekly Advisor, Issue 36, September 9, 2009

    Might there be a little friendly competition between RACs and MACs?

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...

CMS revises selection criteria for RAC adjustment crossover claims and fully reimbursable Part B claims

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

    On August 7, CMS issued transmittal R1793CP to modify one aspect of the logic that the Part A...

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 Region D News Alert: HealthDataInsights launches new RAC Web site, posts issues eligible for audits

  • HCPRO Website, Issue 1, August 13, 2009

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

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?

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...

CMS clarifies how it will treat claims associated with denied inpatient stays

  • Recovery Auditor 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...

Revenue Cycle Institute releases POA White Paper

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

    The Revenue Cycle Institute has released a new white paper, “Present on Admission: Accurate...

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...

Physician advisors and RACs: Saving grace, defending dollars

  • Recovery Auditor Report, Issue 14, July 9, 2009

    When it comes to surviving RACs, effective physician advisors can be a “saving grace,&rdquo...

Revenue Cycle Institute posts free IPPE template

  • Recovery Auditor Report, Issue 14, July 9, 2009

    Take advantage of a handy tool to ensure that your physicians don’t overlook Initial...

CMS updates Medicare Financial Management Manual RAC information

  • Recovery Auditor Report, Issue 13, June 25, 2009

    On June 12, CMS updated the Medicare Financial Management Manual with information pertaining to the...

Hospital shares experience, tips for surviving RAC audits

  • Recovery Auditor Report, Issue 13, June 25, 2009

    One of the best ways to prepare for a RAC audit comes in learning from survivors. Elizabeth Lamkin...

Q&A: RACs and Physician Offices

  • Recovery Auditor Report, Issue 13, June 25, 2009

    Q. Our Midwestern physician practice that has more than 30 physicians. Are physician offices...

Essential questions every HIM director should ask about RAC record requests

  • Recovery Auditor Report, Issue 13, June 25, 2009

    When planning for RAC record requests, HIM directors should ask several essential questions.

Reimbursement for medical record copying costs

  • Recovery Auditor Report, Issue 13, June 25, 2009

    Q: If you submit requested medical records to RACs via CD, are you still reimbursed copying costs...

Additional CMS RAC FAQ clarify provider questions

  • Recovery Auditor Report, Issue 12, June 11, 2009

    CMS released 14 new RAC FAQ June 3.

CMS postpones RAC complex reviews of medical necessity until 2010

  • Recovery Auditor Report, Issue 12, June 11, 2009

    CMS anticipates RAC automated reviews will begin in late June and July, according to Marie Casey...

CMS replaces the term 'observation status' with 'observation services'

  • Recovery Auditor Report, Issue 12, June 11, 2009

    In the July 2009 quarterly updates, CMS revised portions of both the Claims Processing Manual and...

Revenue Cycle Institute posts free ABN Audit Preparation tool

  • Recovery Auditor Report, Issue 12, June 11, 2009

    Help ensure your facility properly obtains ABNs from patients for Medicare noncovered services with...

CMS releases four new and updated RAC FAQ

  • Recovery Auditor 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...

Q&A: RACs and InterQual

  • Recovery Auditor 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...

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...

RACs and Medicare Advantage

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

    Q: Are the Medicare Advantage plans included in RAC audits?

Take our survey; Be part of a comprehensive look at national RAC preparedness

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

    We invite you to take our comprehensive survey on what your facility is doing to prepare for the...

Revenue Cycle Institute announces 'Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role of Physician Advisors'

  • Recovery Auditor Report, Issue 10, May 14, 2009

    The “Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role...

CMS posts RAC Open Door Forum call transcript, recording

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

    CMS has posted the recording, transcript and other related information from the April 8 RAC Open...

AHA issues Member Advisory on RAC program

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

    The American Hospital Association (AHA) has shared what it knows about RACs via a Member...

Q&A: Medical record request limit calculations

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

    Q: We have been trying to calculate the outpatient hospital medical record request limits...

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.

Recovery Audit Contractor Defense conference recordings available

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

    Recordings of the following “Recovery Audit Contractor Defense: A RAC Readiness Summit&rdquo...

Lawsuit says RACs violate CMS' own regulations

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

    Are RACs violating CMS’ own rules? Palomar Medical Center in Escondido, CA believes they are.

CMS updates RAC outreach schedule, FAQs

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

    CMS has updated its RAC education and outreach schedule. The schedule contains new information...

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...

Did you know . . . Five CMS RAC Open Door Forum facts

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

    According to CMS, as noted in the April 14 Medicare RAC Special Open Door Forum, the following are...

New free tools and Revenue Cycle Institute updates

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

    If you haven’t visited the Revenue Cycle Institute Web site recently, now is a good time. In...

CMS announces RAC Open Door Forums

  • Recovery Auditor 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...

Revenue Cycle Institute releases new injection and infusion White paper

  • Recovery Auditor Report, Issue 7, April 2, 2009

    The HCPro Revenue Cycle Institute released a new White paper on injection and infusion coding and...

Q&A: RACs and critical access hospitals

  • Recovery Auditor 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...

Tip: Find out how non-hospital providers can get the RAC education they

  • Recovery Auditor Report, Issue 7, April 2, 2009

    CMS has recently announced the first round of provider information and outreach sessions on RACs...

Share your RAC appeal experiences

  • Recovery Auditor Report, Issue 7, April 2, 2009

    If you’ve experienced RACs at your facility during the demonstration project, we want to hear...

And the winner is . . .

  • Recovery Auditor Report, Issue 7, April 2, 2009

    Thanks to all who participated in our contest! In the previous issue of The RAC Report, we featured...

CMS rescinds and replaces previous RAC transmittal

  • Recovery Auditor Report, Issue 6, March 19, 2009

    On March 6 CMS issued Transmittal 148 rescinding and replacing previous instruction regarding the...

Q&A: RACs and readmissions

  • Recovery Auditor Report, Issue 6, March 19, 2009

    Q: A provider does three different procedures in three different days. Is this acceptable? Are RACs...

Tip: Have clear documentation when sepsis or SIRS is POA

  • Recovery Auditor Report, Issue 6, March 19, 2009

    Never assume that sepsis is present on admission (POA). Sepsis or severe sepsis may be present on...

Test your RAC knowledge to win

  • Recovery Auditor Report, Issue 6, March 19, 2009

    Think you know everything there is to know about RACs? Test your knowledge and enter to win!

Tip: Look into the future

  • Recovery Auditor Report, Issue 5, March 5, 2009

    RACs cannot randomly select or target a claim “solely because it is a high-dollar...

Provider Q&A: Directing RAC correspondence

  • Recovery Auditor 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...

Trivia winner announced!

  • Recovery Auditor Report, Issue 5, March 5, 2009

    Find out the answers to the trivia questions we asked in the previous issue of The RAC Report.

Trivia: RAC your brain for a chance to win!

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

    Editor’s note: Answer all the questions correctly and submit your answer on or before...

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...

Tip: Tune in to RAC outreach sessions and town hall meetings

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

    The announcement from CMS officially kicks the RAC program back into gear. Hospitals and providers...

In case you haven't heard...

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

    CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...

Take-home hints on the MSP

  • Patient Access Weekly Advisor, Issue 5, February 11, 2009

    Use these Medicare Secondary Payer tips in order to remain compliant and obtain full reimbursement.

RAC Protest Resolved: CMS to Continue Implementation

  • HCPRO Website, Issue 4, February 6, 2009

    CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...

Tip: Address one-day stays before the RAC permanent program begins

  • Recovery Auditor 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...

Help ensure RAC-friendly inpatient coding: The importance of discharge notes

  • Recovery Auditor Report, Issue 3, February 5, 2009

    Most inpatient coders are accustomed to seeing “probable,” “suspected,&rdquo...

Sample tools, e-mail news updates, and more

  • Recovery Auditor Report, Issue 3, February 5, 2009

    We’ve added several new features to our Revenue Cycle Institute Web site...

Prepare for approaching ABN deadline

  • Patient Access Weekly Advisor, Issue 4, February 3, 2009

    Mandatory use of the new ABN form will be here before you know it.

Understand the intricacies of medical necessity

  • Recovery Auditor Report, Issue 2, January 22, 2009

    Medical necessity is complex because there is debate regarding what constitutes...

Take note: 10 RAC facts to consider

  • Recovery Auditor Report, Issue 2, January 22, 2009

    Consider the following 10 RAC facts as you prepare for RACs to go live in your area.

Obama promises quality; Dunn Memorial already delivers

  • Patient Access Weekly Advisor, Issue 2, January 21, 2009

    Inauguration speeches are all about promises. Dunn Memorial Hospital’s patient access team...

Update: CMS releases updated RAC demonstration report

  • Recovery Auditor Report, Issue 11, January 8, 2009

    On January 6 CMS released an update to its three-year RAC demonstration program report previously...

Tip: Stay on top of common coding pitfalls

  • Recovery Auditor Report, Issue 10, December 24, 2008

    Although coding denials did not remain the focus by the end of the demonstration project, and...

Reader response: Don't forget Condition Code 44

  • Recovery Auditor Report, Issue 10, December 24, 2008

    By Barbara Aubry, RN, CPC, CHCQM, FAIHQ As mentioned in the previous issue of the RAC Report...

CMS updates: Contacting CMS in regards to RAC-reviewed claims and RAC ODF transcripts

  • Recovery Auditor Report, Issue 10, December 24, 2008

    Are you questioning a claim reviewed by a RAC during the demonstration project? If so, CMS...

FAQ: CMS releases updated answers to RAC questions

  • Recovery Auditor Report, Issue 9, December 11, 2008

    CMS posted new and updated RAC FAQs on the CMS Web site on December 2.

Tip: Get physicians on board to lessen the effects of RACs

  • Recovery Auditor Report, Issue 9, December 11, 2008

    If documentation in the medical record is not accurate, complete and timely patient care can be...

CMS revises reporting form to distinguish between RAC and other appeals

  • Recovery Auditor Report, Issue 9, December 11, 2008

    In Transmittal 144, released November 28, CMS revised its Monthly Statistical Report on...

CMS rescinds and replaces previous transmittal on Medicare deductible, coinsurance, and premium rates for 2009

  • Patient Access Weekly Advisor, Issue 78, November 26, 2008

    CMS tweaked its transmittal updating the Medicare deductible, coinsurance, and premium rates for...

Patients don't understand Medicare coverage gap

  • Patient Access Weekly Advisor, Issue 77, November 19, 2008

    Revenue cycle managers must continue to prepare their staff members to help confused patients with...

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...

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...

Q&A: Medical records request

  • Recovery Auditor Report, Issue 6, October 30, 2008

    Question: Under what circumstances can a RAC make a finding that an overpayment or underpayment...

NEWS: Medicare fraud suspected in Miami

  • Patient Access Weekly Advisor, Issue 71, October 8, 2008

    Federal regulators are investigating charges to Medicare in the Miami area, where government costs...

SPEAKING OF MSP: Tips to monitor staff members’ efficiency

  • Patient Access Weekly Advisor, Issue 69, September 24, 2008

    Check out these MSP tips provided by Stephanie Smithson, CHAM, patient access manager at Dunn...