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Recovery Auditor Report

The Recovery Auditor 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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Recovery Auditor Report

Issue 24, December 30, 2010

• RAC talk: A few minutes with Bill Malm

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

• AHA comments on Medicaid RAC proposed rule

  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

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

• Make sense of Medicaid RACs

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

• Recent RAC activity

  HealthDataInsights adds two new issues across two categories

• Happy Holidays from HCPro, Inc.

  Dear readers,

Issue 23, December 16, 2010

• CMS publishes RAC improper payment vulnerabilities for physicians

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

• RAC Talk: A few minutes with Yvonne Focke

  Name: Yvonne Focke, RN, BSN, MBA

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

  EHR Incentive program overview and update

• CMS now requiring ABN review as part of ADR

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

• New! Revenue Cycle Institute releases 2010 RAC Benchmark Report

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

• Recent RAC Activity

  DCS Healthcare adds 23 issues across four categories

• Revenue Cycle Institute issues free monthly tool

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

Issue 22, December 2, 2010

• Claim closed: How the demonstration can teach us about RAC-withdrawn reviews

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

• RAC talk: A few minutes with Elizabeth Lamkin

  Name: Elizabeth Lamkin Title: President  

• From the field: Recoupment before receipt of demand letters

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

• CMS releases additional documentation request limits for providers

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

• Recent RAC activity

  CGI adds new RAC issue in two separate categories

• Revenue Cycle Institute issues free monthly tool

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

Issue 21, November 11, 2010

• CMS takes first step toward Medicaid RAC implementation

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

• RAC talk: A few minutes with Nancy Hirschl

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

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

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

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

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

• Recent RAC Activity

  DCS Healthcare posts new issue for DRG validation claims

Issue 20, October 28, 2010

• Talking RACs with Kimberly Anderwood Hoy

  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

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

• CMS implements hospital-friendly reforms to Medicaid Integrity Program

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

• OIG reviews CMS use of error rate data

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

• Recent RAC Activity

  CGI adds new issue for DME claims

Issue 19, October 14, 2010

• CMS launches first quarterly newsletter on avoiding common billing errors

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

• A few minutes with Donna Wilson

  Name: Donna Wilson, RHIA, CCS

• Recent RAC activity

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

• CMS issues letter to state Medicaid directors on RAC expansion

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

• OIG issues 2011 Work Plan

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

• Revenue Cycle Institute posts free monthly tool

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

• Revenue Cycle Institute releases ICD-10 white paper

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

Issue 18, September 30, 2010

• CMS publishes RAC improper payment vulnerabilities

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

• Medical Necessity RAC Strategies

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

• Recent RAC Activity

  DCS Healthcare posts new issue

• CMS provides clarification to condition code 44 billing

  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

  Hospital quality update

• Manage medical necessity and improve appeals

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

Issue 17, September 16, 2010

• CMS laying groundwork for Medicaid RACs

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

• Q&A: Academic medical center RAC vulnerabilities

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

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

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

• Recent RAC activity

  DCS Healthcare adds first medical necessity issues for review

• Revenue Cycle Institute posts free monthly tool

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

• From the field: Share your RAC story

  Help us to understand your RAC experience.  

Issue 16, August 5, 2010

• Inpatient admissions decision fuels RAC uncertainty

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

• Seven tips for RAC Region D providers

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

• RACs deny post-discharge queries

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

• Take advantage of nine tips for RAC appeal success

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

• Recent RAC activity

  Connolly adds nine new RAC issues across three categories

• Recent RAC Activity

  DCS Healthcare posts two new RAC issues

• Understand Medicare?s three-day payment window

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

• Revenue Cycle Institute posts free monthly tool

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

• CMS posts 2011 IPPS final rule

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

• Seven Tips For RAC Region A Providers

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

• CMS posts new RAC questions and answers

  CMS posts new RAC questions and answers

Issue 15, July 22, 2010

• CMS release highlights RAC vulnerabilities

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

• CMS approves 18 medical necessity issues for RAC review

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

• Revenue Cycle Institute issues clarification regarding three-day rule

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

• Eight concepts to consider regarding the three-day rule

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

• Five front-end tips to consider for Region C providers

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

• CMS responds to OIG review of rehab facilities

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

• Recent RAC activity

  CGI adds three new RAC issues for DRG validation claims

• Recent RAC Activity

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

• CMS issues proposals for new physician supervision requirements

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

• July 15 CMS Hospital and Hospital Quality Open Door Forum summary

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

• Revenue Cycle Institute releases Clinical Documentation Improvement white paper

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

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

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

Issue 14, July 8, 2010

• Hospitals face three-day payment window changes

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

• Recent RAC Activity

  CGI adds 10 new RAC issues for DRG validation claims

• Revenue Cycle Institute releases Critical Access Hospitals white paper

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

• Revenue Cycle Institute posts free monthly tool

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

• Additional CMS updates

  On June 22, CMS posted a special edition MLN Matters article to provide information about ICD-10...

Issue 13, June 24, 2010

• CMS update indicates high provider success rate for appealing denials

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

• Recent RAC Activity

  DCS Healthcare posts 23 new RAC issues

• Missing RAC records: Another snag thrown at providers

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

• Reduce RAC vulnerabilities with a quality CDI program

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

• OIG continues to review oxaliplatin billing

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

Issue 12, June 10, 2010

• RAC: The Problem With The Three-Day Rule

  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

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

• HealthDataInsights posts two new RAC issues for Part B claims

  HealthDataInsights has added two new RAC issues for Part B claims review to its CMS-approved list...

• 2010 RAC Benchmarking Survey

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

• RAC Appeals: Master the Process and Overturn Denials

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

Issue 11, May 27, 2010

• Recent RAC Activity

  DCS Healthcare posts 3 new RAC issues for DRG validation review

• More than just RACs: Hospital shares its MIC experience

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

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

  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

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

• Revenue Cycle Institute posts free monthly tool

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

• 2010 RAC Benchmarking Survey

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

Issue 10, May 13, 2010

• Prepare for impending RAC medical necessity reviews

  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

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

• RAC 101 Q&A fields questions from providers nationwide

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

• Recent change in CMS manual aims to improve RAC program

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

• From the field: Share your RAC story

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

• CMS releases RAC related transmittals

  CMS updates MAC business requirements regarding RACs

• Watchdog advisory and monitoring services

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

Issue 9, April 29, 2010

• Recent RAC activity

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

• CMS seeks to end remittance advice confusion

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

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

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

• From The Field: RAC experiences

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

• Revenue Cycle posts free monthly tool

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

Issue 8, April 15, 2010

• Recent RAC Activity

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

• From The Field: RAC experiences

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

• RACs expanding into Medicaid

  As part of the Patient Protection and Affordable Care Act, which was recently signed into law by...

• GAO examines RAC vulnerabilities

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

• CMS reaching out to providers on RAC issues

  CMS announced a series of nationwide RAC 101 calls.

Issue 7, April 1, 2010

• Recent RAC Activity

  DCS Healthcare posts 3 new issues for DRG validation reviews

• Clearing the confusion around the three-day rule

  The three-day payment window rule has remained unchanged since its implementation in 1998, yet much...

• Finding success in the RAC discussion period

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

• Health Reform Brings Changes, More Work for HIM

  After an eventful week on Capitol Hill, HIM directors are likely wondering how health reform will...

• CMS publishes provider option chart

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

• Appeals council issues a ?partially favorable? decision

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

Issue 6, March 18, 2010

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

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

• RAC audits now a potential risk for physicians

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

• Combat potential undercoding due to fear of RAC denials

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

• White House memorandum mandates additional recovery audits

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

• Revenue Cycle Institute posts free monthly tool

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

Issue 5, March 4, 2010

• Recent RAC Activity

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

• Admit it: Admission orders important in era of audits

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

• Understanding and Avoiding RAC Fraud

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

• RAC extrapolation: Potential impact and how to prepare

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

• RACs not authorized to review all IRF claims

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

• Revenue Cycle Institute releases 2010 Medicare Consultation Changes white paper

  The Revenue Cycle Institute has released a new white paper, “2010 Medicare Consultation...

• The year of the audit

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

Issue 4, February 18, 2010

• Recent RAC Activity

  Connolly Healthcare, HealthDataInsights, CGI post new RAC issues.

• Dealing with Audit MICs from start to finish

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

• CMS to expand 2010 additional documentation requests limits

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

• Medicare Membership Program

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

• Brush up on sequencing as RAC complex reviews get under way

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

• Join a community to talk all things audit

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

Issue 3, February 4, 2010

• CGI adds new DRG validation issues

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

• CMS expands medical request limits to all institutional providers

  CMS has expanded its fiscal year 2010 RAC additional documentation requests (ADR) (i.e., medical...

• Avoiding interest rates: Pay first, appeal after

  CMS released a transmittal in mid-January instructing Medicare contractors to implement an interest...

• A closer look into DRG validation issues

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

• What could the RACs be thinking?

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

• Share your RAC story

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

• Revenue Cycle posts free monthly tool

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

• Medicaid Integrity Contractors: We want to hear from you

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

Issue 2, January 21, 2010

• HealthDataInsights posts dozens of new RAC issues for Region D

  HealthDataInsights (HDI) has added dozens of new RAC issues for all states in Region C, according...

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

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

• CGI posts new RAC issues for Region B states

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

• AHA urges Congress to remove Medicaid RAC provision

  In a January letter to Congress that addresses several concerns and comments on current healthcare...

• HealthDataInsights, providers eyeing underpayment issues

  In recent weeks, HealthDataInsights (HDI) has added dozens of new issues to its CMS-approved list...

• Medically unlikely edits creating cause for concern

  Connolly Healthcare and CGI recently added Medically Unlikely Edits (MUE) for outpatient hospital...

• Setting up for success in handling RAC and MIC audits

  During RAC and MIC audits, healthcare providers face an important task: Making the decision to...

• Post announcing new white paper on RCI site

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

Issue 1, January 7, 2010

• Connolly posts dozens of new RAC issues for Region C

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

• DCS Healthcare posts new DME claim RAC issues

  DCS Healthcare has added six RAC issues for DME claim review to its CMS-approved list for providers...

• CMS releases 16 new, updated RAC FAQ

  CMS released several new and updated FAQ on its Web site in December. The questions are as follows:

• Tips to help master medical necessity

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

• Help ensure successful RAC appeals

  Appealing RAC denials is certainly a complex process, but providers can take certain steps to...

• Revenue Cycle Institute post free monthly tool

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