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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 26, December 29, 2011

• CMS releases details of recovery auditor prepayment review demonstration

  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

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

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

  Hospital and CAH conditions of participation proposed rule

• Recent RAC activity

  DCS Healthcare posts 45 new issues across two categories

Issue 25, December 15, 2011

• From the field: Demand letter confusion

  A compliance director at a hospital in Region C (who wished to remain anonymous) shared one of her...

• Physician supervision clarification still causing confusion

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

• Revenue Cycle Institute posts free monthly tool

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

• HCPro's 2011 Recovery Auditor Benchmarking Survey

  Be part of a comprehensive assessment of the recovery auditor program and learn how facilities...

• Recent RAC activity

  DCS Healthcare posts new issue for professional services claims

Issue 24, December 1, 2011

• The three-day payment window and new PD modifier

  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

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

• Recent RAC activity

  DCS Healthcare posts 66 new issues for medical necessity claims

Issue 23, November 17, 2011

• CMS announces major efforts to help reduce Medicare, Medicaid improper payments

  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

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

• Recent RAC activity

  DCS Healthcare posts 36 new issues for medical necessity claims

Issue 22, November 3, 2011

• CMS launches second volume of quarterly compliance newsletter

  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

  The American Hospital Association (AHA) will host four members-only conference calls—one for...

• Recent RAC activity

  DCS Healthcare posts 20 new issues for medical necessity claims

• 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 recovery auditor story

  Help us to understand your RAC experience.

Issue 21, October 20, 2011

• Medical necessity and RAC tracking management best practices

  The following a checklist of best practice techniques when it comes to medical necessity and RAC...

• Recent RAC activity

  CGI posts new issue for DME claims

• The RAC Toolkit for Physician Practices

  RACs are auditing practices. Learn how to prepare.

Issue 20, October 6, 2011

• RAC readiness for automated reviews

  While automated reviews do not require medical record (MR) review, they are the most difficult to...

• Recent RAC activity

  DCS Healthcare posts four new issues for medical necessity claims

• HCPro Watchdog Service

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

Issue 19, October 6, 2011

• Q&A: Three-day payment window

  The following is adapted from an actual Q&A between a listener from an HCPro audio conference...

• New! Revenue Cycle Institute releases Principal Diagnosis Selection White Paper

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

• Recent RAC activity

  CGI posts new issue for professional claims

Issue 18, September 8, 2011

• Assessing and quantifying your risk for RAC recoupments

  Editor’s note: This article was excerpted from the new HCPro book, “The RAC Toolkit for...

• Recent RAC activity

  CGI posts new issue for professional claims

• Revenue Cycle Institute posts free monthly tool

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

• 2012 IPPS Final Rule Explained

  The sheer volume of new payment information in the 2012 IPPS Rule makes the rule difficult to...

Issue 17, August 25, 2011

• Additional documentation limits raised for certain providers

  As of August 22, recovery auditors can request up to 35 records per 45 days from non-supplier and...

• Recent RAC activity

  CGI posts three new issues across two categories

• Revenue Cycle Institute posts free monthly tool

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

• Medicare compliance: Let the rules fuel your decisions

  When you understand Medicare's rules and regulations you'll create a solid foundation to protect...

Issue 16, August 11, 2011

• Demand letter responsibility shifted from RAC to MAC

  Recovery audit contractors had previously been responsible for issuing demand letters to providers...

• CMS posts IPPS final rule for FY 2012

  CMS has released a display copy of the IPPS final rule for fiscal year (FY) 2012.

• Recent RAC activity

  DCS Healthcare posts two new issues for medical necessity claims

Issue 15, July 28, 2011

• Recent RAC activity

  DCS Healthcare posts new issue for DME claims

• CMS publishes OPPS proposed rule

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

• Combat RAC Denials

  RAC and other government auditor denials continue to mount up and it’s more important than...

Issue 14, July 14, 2011

• CMS releases 2012 OPPS proposed rule

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

• Recent RAC activity

  DCS Healthcare posts two new issues for medical necessity claims

• Revenue Cycle Institute posts free monthly tool

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

Issue 13, June 30, 2011

• CMS discloses DRG coding vulnerabilities for inpatient hospitals

  In an effort to provide helpful information to providers, CMS released a special edition MedLearn...

• Provider-friendly change to tracking observation hours

  In the July OPPS update, CMS made a manual change to the section on counting observation hours that...

• Recent RAC activity

  DCS Healthcare posts new issue for medical necessity claims

• June 1 Hospital & Hospital Quality Open Door Forum Summary

  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

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

Issue 12, June 16, 2011

• CMS issues clarification on services made "under arrangement"

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

• The new frontier of coverage denials

  This week CMS released a special edition MLN Matters article reviewing the coverage of percutaneous...

• Recent RAC Activity

  DCS Healthcare posts 11 new issues for medical necessity claims

Issue 11, June 2, 2011

• CMS adjusts payment policy for replacement devices in IPPS proposed rule

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

• Focus on prevention of future recoupments

  The long-term goal for every facility facing RAC should be to avoid RAC recoupments by ensuring...

• Recent RAC activity

  DCS Healthcare posts five new issues for medical necessity claims

• Revenue Cycle Institute posts free monthly tool

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

Issue 10, May 19, 2011

• Three-day rule clarification issued in IPPS proposed rule

  On April 19, CMS released the inpatient prospective payment system proposed rule for 2012, which...

• April 27 Hospital & Hospital Quality Open Door Forum Summary

  A representative from the Office of Clinical Standards and Quality suggested to the audience that...

• MAC settles long-running inpatient billing debate

  Noridian Administrative Services LLC, Medicare administrative contractor (MAC) for Montana, North...

• Recent RAC activity

  DCS Healthcare posts three new issues for medical necessity claims

Issue 9, May 5, 2011

• CMS identifies total improper payment figures; top RAC issue per region

  CMS released a short but useful Recovery Audit Contractor (RAC) update on its website that reports...

• CMS issues latest quarterly provider compliance newsletter

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

• Note: CMS publishes IPPS proposed rule for 2012

  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

  On April 27, the physician regulatory issues team (PRIT) discussed the audit of infusion code...

• New! Revenue Cycle Institute releases CDI-RAC White Paper

  The Revenue Cycle Institute has released a new white paper, “RAC Preparedness: Five Ideas for...

• Recent RAC activity

  DCS Healthcare posts 23 new issues for medical necessity claims

Issue 8, April 21, 2011

• From the field: Discovering errors when receiving an ADR

  While reviewing medical records as part of an additional documentation request, a RAC coordinator...

• Recent RAC activity

  DCS Healthcare posts three new issues for medical necessity claims

• Revenue Cycle Institute posts free monthly tool

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

Issue 7, April 7, 2011

• RACs using 'semi-automated' claims review

  Providers familiar with automated claims reviews and complex claims reviews by the recovery audit...

• Recent RAC activity

  DCS Healthcare posts seven new issues for DRG validation claims

• CMS podcast addresses high-risk medical necessity vulnerabilities

  CMS’ Medicare Learning Network® has released the first in a series of podcasts designed...

• 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...

• Revenue Cycle Institute posts free monthly tool

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

Issue 6, March 24, 2011

• GAO study identifies strategies for CMS to reduce improper payments, offers Medicaid RAC program update

  A Government Accountability Office (GAO) study released March 9 identifies five ways in which GAO...

• CMS instructs on coding of place of service codes

  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

  Pre-existing condition insurance plans A representative from the Centers of Consumer Information...

• Recent RAC Activity

  Connolly posts six new RAC issues across six categories

Issue 5, March 10, 2011

• AHA weighs in on Part C RACs

  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

  Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to...

• CMS raises documentation request limits for certain hospitals

  CMS recently increased the number of medical records that recovery audit contractors (RAC) can...

• Recent RAC activity

  DCS Healthcare posts 29 new issues across two categories

• Revenue Cycle Institute posts free monthly tool

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

Issue 4, February 24, 2011

• CMS announces electronic data submission tool for providers

  As it currently stands, providers respond to documentation requests from review contractors such as...

• Recent RAC activity

  DCS Healthcare posts 12 new issues across three categories

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

  The Revenue Cycle Institute has released a new white paper, “Master the Intricacies of the...

• CMS issues second quarterly provider compliance newsletter

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

• CMS delays Medicaid RAC implementation

  As some expected, the expansion of Medicaid recovery audit contractors (RAC) is proving difficult.

• CMS releases additional documentation request limits for physicians/non-physician practitioners

  In response to feedback from the RACs, physicians and their associations, CMS modified the...

Issue 3, February 10, 2011

• From the field: Inpatient admission date and time compliance

  This past summer when the first Recovery Audit Contractor (RAC) approved the issue “inpatient...

• Inpatient-only procedures and the three-day rule

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

• January 12 Hospital & Hospital Quality Open Door Forum Summary

  A CMS representative began the presentation portion of the call by talking about admissions...

• Recent RAC activity

  CGI removes four DRG validations issues

• HCPro Watchdog Service

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

Issue 2, January 27, 2011

• CMS issues guidance on hospital inpatient admission decisions

  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

  Name: Nancy J. Beckley, MS, MBA, CHC Title: President  

• Recent RAC Activity

  DCS Healthcare posts seven new issues for DRG validation claims

• Revenue Cycle Institute One-Question Poll

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

• CMS issues FAQ on 60-day determination requirement

  CMS has posted the following frequently asked question:

• Revenue Cycle Institute posts free monthly tool

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

Issue 1, January 13, 2011

• RAC talk: A few minutes with Stacey Levitt

  Name: Stacey Levitt, RN, MSN, CPC Title: Senior Administrative Director of Patient Care...

• Recent RAC activity

  HealthDataInsights adds four new issues for Part A inpatient claims review

• Revenue Cycle Institute posts free monthly tool

  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

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

• Medicare Membership Program

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