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The RAC Report

The RAC Report is a free biweekly e-newsletter of useful tips and strategies to get you prepared for the arrival of Medicare's Recovery Audit Contractors (RACs).

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The RAC Report

Issue 10, December 24, 2008

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

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

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

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

• Revenue Cycle Institute releases updates to Revenue Cycle white papers

  The Revenue Cycle Institute announces new and updated white papers available for download. In...

• Reader response: Don't forget Condition Code 44

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

• Tip: Stay on top of common coding pitfalls

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

Issue 9, December 11, 2008

• CMS revises reporting form to distinguish between RAC and other appeals

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

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

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

• FAQ: CMS releases updated answers to RAC questions

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

• Quote of the week: For the sports fans out there

  “Offense sells tickets. Defense wins championships.” —Michael Taylor, MD, senior...

Issue 8, November 26, 2008

• Update: RAC medical record request limits

  It looks like healthcare providers can count on the RAC medical record request limitations...

• News: CMS reports decrease in improper payments

  Improper payments for Medicare fee-for-service (FFS) decreased from 3.9% to 3.6% in fiscal year...

• Tip: Review OIG publications for hints

  The permanent RAC program may be on hold for a short time. However, this doesn’t mean you...

• Q&A: One of the challenges that many providers have faced is the inability to sufficiently interface (e.g., to see a human, get a return phone call, or otherwise interact in a personalized manner) with a RAC with respect to questions, concerns or confusion that occasionally arise.

  Q&A: One of the challenges that many providers have faced is the inability to sufficiently...

Issue 7, November 13, 2008

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

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

• Dig out your calculators: CMS announces RAC medical record request limitations

  On October 30, CMS announced limitations on the number of medical records RACs could request for...

• Update: CMS delays RAC permanent program

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

• Quote of the week

  “The bottom line is, from where I sit, RACs are here to stay and this little hiccup, even if...

• CMS RAC Open Door forum update

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

Issue 6, October 30, 2008

• Facilities avoiding self-audits

  The buzz in the industry is many hospitals nationwide have not performed self-audits because they...

• Q&A: Medical records request

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

• Key differences in nationwide rollout

  Vulnerability reporting; standardized base notification of overpayment letters to providers. Learn...

• Scoop on HDI

  You may want to know about this RAC contractor -- it had the most denials overturned on appeals...

Issue 5, October 16, 2008

• CMS hires RAC Validation Contractor

  The RAC Validation Contractor (RVC) will work with CMS and the RACs to approve new issues the RACs...

• Contingency fees announced

  RACs get paid “contingency fees” based on the amount of the improper payments they...

• Q&A: Critical Access Hospitals

  Question: Are Critical Access Hospitals safe from a RAC audit? Answer: No. Medicare auditors can...

• Key differences in nationwide rollout

  CMS revamped the program after the three-year demonstration project, and providers can expect to...

Issue 4, October 2, 2008

• CMS publishes new numbers on RAC demonstration project

  Of the number of claims with overpayment determinations (525,133), providers have won 35,819 on...

• CMS to publish edits in its Medically Unlikely Edit (MUE) program

  CMS established the MUE program January 1, 2007, to ensure providers and suppliers do not report...

• Getting prepared

  A comprehensive checklist to prepare you for a RAC visit.

• Q&A: RAC review

  Question: If a provider has performed a self-audit prior to RAC review and wants to extrapolate...

Issue 3, September 18, 2008

• Revised timeline for RACs

  CMS had not listed an exact start time for the permanent RACs until the government's announcement...

• Tips to prepare for RACs

  Think you're RAC ready? Apply these tips to your preparation process.

• California Hospital Association questions CMS numbers from demonstration project

  Regarding these concerns, Rep. Lois Capps, D-California, wrote a letter to Tim Hill, Office of...

• MSP tips to monitor staff members' efficiency

  Look at the training materials, the accuracy rates and the processes you have in place to see where...

Issue 2, September 4, 2008

• What RACs are looking for

  Nancy Hirschl, president of Hirschl and Associates in Laguna Niguel, CA, and a RAC Report Advisory...

• California Hospital Association questions CMS numbers from demonstration project

  The California Hospital Association released a memorandum to HCPro Inc. that cites “several...

• Medicare officials underestimate incorrect payments on medical equipment

  WASHINGTON – Nearly 30% of sampled claims for durable medical equipment were made incorrectly...

• A checklist to get MSP compliant

  The following are two important tips regarding the MSP from Kimberly Anderwood Hoy, JD, CPC...

Issue 1, August 19, 2008

• GAO plans a review of RAC program

  The Government Accountability Office plans to begin a review of the Medicare RAC program near the...

• Things you need to know about RACs

  The RACs corrected more than $1 billion of Medicare improper payments from 2005 through March 27...

• Get your appeals process ready

  “You need to fight back or you’re going to have a target on your head,” says...

• Who should be on your organization's RAC task force?

  Team members should represent all facets of the revenue cycle.