Revenue Cycle Articles by Topic: Medicare Coverage and Reimbursement
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HCPRO Website, Issue 20, March 5, 2013
Providers and payers alike have to stay on top of a regulatory environment that is constantly...
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Recovery Auditor Report, Issue 24, November 29, 2012
Connolly posts 24 new issues across five categories
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Recovery Auditor Report, Issue 24, November 29, 2012
On November 15, the OIG issued a review of ALJ appeals decided in fiscal year 2010.
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Recovery Auditor Report, Issue 24, November 29, 2012
CMS issues notice on hospital outpatient payment panel
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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...
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Medicare Update for CAHs, Issue 24, November 28, 2012
CMS issues press release on ACA impact on payments to primary care physicians
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Recovery Auditor Report, Issue 23, November 15, 2012
On October 16, it was reported that legislation was introduced by Representative Sam Graves (R-MO...
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Recovery Auditor Report, Issue 23, November 15, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 23, November 15, 2012
HealthDataInsights posts four new issues across two categories
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Recovery Auditor Report, Issue 23, November 15, 2012
The 2013 Outpatient Prospective Payment System final rule finalizes ambulatory payment...
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Medicare Update for CAHs, Issue 23, November 14, 2012
Editors note: This article was written by Debbie Mackaman, RHIA, CHCO, regulatory specialist for...
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Recovery Auditor Report, Issue 22, November 1, 2012
Editor’s note: This article originally appeared in the CDI Journal.
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Recovery Auditor Report, Issue 22, November 1, 2012
Representative Sam Graves (R-MO) introduced legislation October 16 that aims to improve the...
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Recovery Auditor Report, Issue 22, November 1, 2012
Performant Recovery posts three issues across two categories
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Recovery Auditor Report, Issue 22, November 1, 2012
Hospital readmissions have the potential to cause a negative financial impact on your facility and...
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Medicare Update for CAHs, Issue 22, October 31, 2012
CMS issues press release on 2013 quality ratings for Medicare health and drug plans
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Medicare Update for CAHs, Issue 22, October 31, 2012
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Medicare Insider, Issue 43, October 23, 2012
The Revenue Cycle Institute has released a new white paper
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Recovery Auditor Report, Issue 21, October 18, 2012
Earlier this year, CMS held its first Hospital Outpatient Payment Panel meeting, which managed to...
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Recovery Auditor Report, Issue 21, October 18, 2012
BC Advantage—a company that provides medical office with in-depth content written by industry...
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Recovery Auditor Report, Issue 21, October 18, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 21, October 18, 2012
HealthDataInsights posts two new issues across two categories, including first prepayment review...
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Medicare Update for CAHs, Issue 21, October 17, 2012
CMS issues preliminary decisions on recommendations of outpatient payment panel on supervision...
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Medicare Update for CAHs, Issue 21, October 17, 2012
A Medicare beneficiary was seen in the hospital emergency department and required extensive nursing...
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Medicare Update for CAHs, Issue 21, October 17, 2012
HealthDataInsights posts two new issues across two categories, including first prepayment review...
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Recovery Auditor Report, Issue 20, October 4, 2012
HCPro and the Revenue Cycle Institute team are proud to announce the 2012 Medicare Compliance Forum
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Recovery Auditor Report, Issue 20, October 4, 2012
DCS issues important provider notice
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Recovery Auditor Report, Issue 20, October 4, 2012
Following the close of each fiscal year (FY) quarter, CMS releases statistics for the amount of...
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Recovery Auditor Report, Issue 20, October 4, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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Medicare Update for CAHs, Issue 20, October 3, 2012
CMS issues press release on Affordable Care Act
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Recovery Auditor Report, Issue 19, September 20, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 19, September 20, 2012
DCS Healthcare posts new issue for inpatient hospital claims
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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...
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Medicare Update for CAHs, Issue 19, September 18, 2012
CMS issues administrative simplification final rule
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Recovery Auditor Report, Issue 18, September 6, 2012
In the recently released 2013 OPPS proposed rule, CMS issued a request for comments that suggests...
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Recovery Auditor Report, Issue 18, September 6, 2012
DCS Healthcare posts new issue for outpatient hospital claims
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Recovery Auditor Report, Issue 18, September 6, 2012
CMS released the October OPPS update this week with a smattering of unrelated, but important...
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Recovery Auditor Report, Issue 18, September 6, 2012
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
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Medicare Update for CAHs, Issue 18, September 5, 2012
Following the announcement of the official start date of prepayment reviews (set to begin August...
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Medicare Update for CAHs, Issue 18, September 5, 2012
CMS announces Stage 2 final rule for Medicare and Medicaid EHR Incentive Programs
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Medicare Update for CAHs, Issue 18, September 5, 2012
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
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Recovery Auditor Report, Issue 17, August 23, 2012
Connolly posts 10 new issues across three categories
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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...
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Medicare Update for CAHs, Issue 17, August 22, 2012
On August 3, CMS issued a transmittal and accompanying MLN Matters article that providers...
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Medicare Update for CAHs, Issue 17, August 22, 2012
CMS issues interim final rule for healthcare EFT and RA transactions
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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...
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Recovery Auditor Report, Issue 15, August 9, 2012
CMS officially announced the Recovery Auditor prepayment review demonstration this past November...
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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.
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Recovery Auditor Report, Issue 15, August 9, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 14, August 9, 2012
DCS Healthcare posts seven new issues across four categories
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Medicare Update for CAHs, Issue 16, August 8, 2012
In addition to proposing to extend the non-enforcement of supervision rules for critical access...
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Medicare Update for CAHs, Issue 16, August 8, 2012
CMS announces two website redesigns
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Medicare Update for CAHs, Issue 16, August 8, 2012
Download this pocket card to use as a helpful tool that provides important “points to...
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Medicare Update for CAHs, Issue 16, August 8, 2012
DCS Healthcare posts new issue for DME claims
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Recovery Auditor Report, Issue 14, July 26, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Medicare Update for CAHs, Issue 15, July 25, 2012
On July 6, CMS released a display copy of the 2013 OPPS proposed rule.
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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.
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Medicare Update for CAHs, Issue 15, July 25, 2012
CGI posts four new issues for physician claims
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Medicare Update for CAHs, Issue 15, July 24, 2012
CMS issues three-day payment window FAQs
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Recovery Auditor Report, Issue 13, July 12, 2012
CMS is proposing two major changes as part of the 2013 Outpatient Prospective Payment System (OPPS...
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Recovery Auditor Report, Issue 13, July 12, 2012
On June 28, CMS replaced transmittal R1088OTN, containing information on the reporting of...
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Recovery Auditor Report, Issue 13, July 12, 2012
CGI posts new issue for outpatient claims
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Medicare Update for CAHs, Issue 14, July 11, 2012
Last November, CMS unveiled three demonstration projects aimed at reducing improper payments in the...
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Medicare Update for CAHs, Issue 14, July 11, 2012
CMS instructs on provider self audits
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Medicare Update for CAHs, Issue 14, July 11, 2012
Dr. Anderson is a physician that covers the emergency department of a critical access hospital...
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Medicare Update for CAHs, Issue 14, July 11, 2012
CGI posts new issue for outpatient claims
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Recovery Auditor Report, Issue 12, June 28, 2012
Last November, CMS unveiled three demonstration projects aimed at reducing improper payments in the...
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Recovery Auditor Report, Issue 12, June 28, 2012
Last week, Kimberly provided an overview of the many significant updates and clarifications that...
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Recovery Auditor Report, Issue 12, June 28, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 12, June 28, 2012
HealthDataInsights posts seven new issues across three categories
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Medicare Update for CAHs, Issue 13, June 27, 2012
Last week, the Medicare Weekly Update provided an overview of the many significant updates and...
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Medicare Update for CAHs, Issue 13, June 27, 2012
A physician ordered a bacterial urine culture (87086) for a Medicare patient from the...
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Medicare Update for CAHs, Issue 12, June 27, 2012
HealthDataInsights posts seven new issues across three categories
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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...
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Recovery Auditor Report, Issue 11, June 14, 2012
In the 2012 outpatient prospective payment system (OPPS) final rule, CMS established a process to...
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Recovery Auditor Report, Issue 11, June 14, 2012
DCS Healthcare posts ten new issues across six categories
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Recovery Auditor Report, Issue 11, June 14, 2012
There were a number of interesting items in the July 2012 Update to the Hospital Outpatient...
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Patient Access Weekly Advisor, Issue 23, June 13, 2012
In the 2012 outpatient prospective payment system (OPPS) final rule, CMS established a process to...
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Patient Access Weekly Advisor, Issue 22, June 6, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
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Recovery Auditor Report, Issue 10, May 31, 2012
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.
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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...
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Medicare Update for CAHs, Issue 11, May 30, 2012
On May 9, CMS released two rules aimed at reducing regulatory burdens for healthcare providers.
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Medicare Update for CAHs, Issue 11, May 30, 2012
CMS releases 2013 IPPS proposed rule
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Medicare Update for CAHs, Issue 11, May 30, 2012
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.
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Patient Access Weekly Advisor, Issue 20, May 23, 2012
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter...
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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...
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Recovery Auditor Report, Issue 9, May 17, 2012
DCS Healthcare posts one new issue into two categories
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Medicare Update for CAHs, Issue 10, May 16, 2012
On April 26, CMS issued transmittal R2452CP that implements the payment methodology for...
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Medicare Update for CAHs, Issue 10, May 16, 2012
CMS issues guidance on determining rural location for swing bed and RHC eligibility
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Medicare Update for CAHs, Issue 10, May 16, 2012
Situation: Jonathan, a 68-year-old Medicare patient, presents to a hospital’s outpatient...
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Medicare Update for CAHs, Issue 10, May 16, 2012
DCS Healthcare posts one new issue into two categories
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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...
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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...
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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...
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Medicare Update for CAHs, Issue 9, May 2, 2012
CMS continues updates to Program Integrity Manual
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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...
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Medicare Update for CAHs, Issue 9, May 2, 2012
DCS Healthcare posts nine new issues across four categories
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Recovery Auditor Report, Issue 7, April 19, 2012
The Revenue Cycle Institute has released a new white paper, “Mastering the Three-Day Payment...
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Recovery Auditor Report, Issue 7, April 19, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 7, April 19, 2012
HHS released a proposed rule yesterday that announces a one-year delay for the implementation of...
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Recovery Auditor Report, Issue 7, April 19, 2012
DCS Healthcare posts eight new issues across four categories
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Medicare Update for CAHs, Issue 8, April 18, 2012
Earlier this year CMS released a transmittal that implements a system update to include the...
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Medicare Update for CAHs, Issue 8, April 18, 2012
CMS revises "incident to" transmittal
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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...
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Medicare Update for CAHs, Issue 8, April 18, 2012
DCS Healthcare posts two new issues for skilled nursing facility claims
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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...
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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...
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Recovery Auditor Report, Issue 6, April 5, 2012
In early March, CMS released two related transmittals that rescinded prior transmittals.
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Recovery Auditor Report, Issue 6, April 5, 2012
DCS Healthcare posts three new issues across two categories
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Medicare Update for CAHs, Issue 7, April 4, 2012
CMS redesigns claims and benefits statement
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Medicare Update for CAHs, Issue 7, April 4, 2012
After reading about another provider’s Recovery Auditor correspondence woes in a February 23...
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Medicare Update for CAHs, Issue 7, April 4, 2012
DCS Healthcare posts new issue for medical necessity claims
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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...
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Recovery Auditor Report, Issue 5, March 22, 2012
On March 12, CMS issued an update that effectively raises the additional documentation requests...
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Recovery Auditor Report, Issue 5, March 22, 2012
After reading about another provider’s Recovery Auditor correspondence woes in a February 23...
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Recovery Auditor Report, Issue 5, March 22, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Medicare Update for CAHs, Issue 6, March 21, 2012
CMS recently released two replacement transmittals that summarize Recovery Auditor-identified...
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Medicare Update for CAHs, Issue 6, March 21, 2012
OIG posts review of Medicare outpatient billing for selected drugs at NorthBay Medical Center (CA)
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Medicare Update for CAHs, Issue 2, March 21, 2012
Question: A Medicare beneficiary who had never before been hospitalized was admitted to and stayed...
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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...
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Recovery Auditor Report, Issue 4, March 8, 2012
What type of impact do you think the newly announced demonstration project for recovery auditor...
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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...
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Medicare Update for CAHs, Issue 5, March 7, 2012
HHS announces intent to delay ICD-10 compliance date
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Medicare Update for CAHs, Issue 5, March 7, 2012
HealthDataInsights posts seven new issues for medical necessity claims
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Recovery Auditor Report, Issue 3, February 23, 2012
On February 9, CMS posted its latest recovery auditor update. The results show a continuing trend...
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Recovery Auditor Report, Issue 3, February 23, 2012
DCS Healthcare posts new issue for DME supplier claims
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Medicare Update for CAHs, Issue 4, February 22, 2012
What type of impact do you think the newly announced demonstration project for recovery auditor...
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Medicare Update for CAHs, Issue 2, February 22, 2012
CMS corrects 2012 payment rate increases for RHCs and FQHCs
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Recovery Auditor Report, Issue 3, February 9, 2012
Get answers to your questions and Medicare compliance guidance from the experts all year long.
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Recovery Auditor Report, Issue 3, February 9, 2012
On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...
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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...
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Recovery Auditor Report, Issue 3, February 9, 2012
Connolly adds 17 new issues across five categories
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Medicare Update for CAHs, Issue 3, February 8, 2012
On January 26, CMS issued a transmittal that implements the multiple procedure payment reduction...
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Medicare Update for CAHs, Issue 3, February 8, 2012
CMS allows physician assistants to perform SNF level of care certifications
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Medicare Update for CAHs, Issue 3, February 8, 2012
HealthDataInsights posts 33 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 3, February 8, 2012
On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...
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Recovery Auditor Report, Issue 2, January 26, 2012
Each quarter CMS issues a recovery audit program update that details the total amount of...
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Recovery Auditor Report, Issue 2, January 26, 2012
In its most recent (January 20) Medicare Quarterly Provider Compliance Newsletter, CMS once again...
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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...
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Recovery Auditor Report, Issue 2, January 26, 2012
DCS Healthcare posts 25 new issues for medical necessity claims
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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...
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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...
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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
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Medicare Update for CAHs, Issue 2, January 25, 2012
DCS Healthcare posts 25 new issues for medical necessity claims
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Recovery Auditor Report, Issue 1, January 12, 2012
On December 29, CMS issued a notice announcing the delay of the recovery audit prepayment review...
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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...
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Recovery Auditor Report, Issue 1, January 12, 2012
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 1, January 12, 2012
DCS Healthcare posts 40 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 1, January 11, 2012
In early November, CMS issued a transmittal that provides the payment rate increases for rural...
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Medicare Update for CAHs, Issue 1, January 11, 2012
CMS creates CO-OP program to expand health plans
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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...
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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...
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Medicare Update for CAHs, Issue 2, January 11, 2012
DCS Healthcare posts 54 new issues across two categories
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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...
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Recovery Auditor Report, Issue 26, December 29, 2011
The Revenue Cycle Institute has released a new white paper, “Physician Supervision: Analyzing...
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Recovery Auditor Report, Issue 26, December 29, 2011
Hospital and CAH conditions of participation proposed rule
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Recovery Auditor Report, Issue 26, December 29, 2011
DCS Healthcare posts 45 new issues across two categories
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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...
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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...
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Medicare Update for CAHs, Issue 14, December 28, 2011
CMS posts instructions for completing Hospital/CAH Database Worksheet
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Medicare Update for CAHs, Issue 14, December 28, 2011
Time limit for filing an appeal after:
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Recovery Auditor Report, Issue 25, December 15, 2011
Be part of a comprehensive assessment of the recovery auditor program and learn how facilities...
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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...
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Recovery Auditor Report, Issue 25, December 15, 2011
In the calendar year (CY) 2012 OPPS Final Rule, CMS once again amended the regulations for...
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Recovery Auditor Report, Issue 25, December 15, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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Medicare Update for CAHs, Issue 13, December 14, 2011
When CMS finalized its physician supervision proposals in the 2012 outpatient prospective payment...
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Medicare Update for CAHs, Issue 13, December 14, 2011
CMS revises the Interpretive Guidelines for hospitals and CAHs
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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...
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Recovery Auditor Report, Issue 24, December 1, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 24, December 1, 2011
DCS Healthcare posts 66 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 12, November 30, 2011
When the 2012 outpatient prospective payment system (OPPS) proposed rule was released, there were a...
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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...
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Medicare Update for CAHs, Issue 12, November 30, 2011
DMEPOS Fee Schedule update
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Medicare Update for CAHs, Issue 12, November 30, 2011
DCS Healthcare posts 66 new issues for medical necessity claims
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Recovery Auditor Report, Issue 23, November 17, 2011
As part of the ongoing effort to reduce improper payments in Medicare and Medicaid, CMS announced...
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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...
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Recovery Auditor Report, Issue 23, November 17, 2011
DCS Healthcare posts 36 new issues for medical necessity claims
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Medicare Update for CAHs, Issue 11, November 16, 2011
On October 28, CMS issued a transmittal that implements the multiple procedure payment reduction...
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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...
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Medicare Update for CAHs, Issue 3, November 16, 2011
CMS issues ACO final rule
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Medicare Update for CAHs, Issue 11, November 16, 2011
By definition critical access hospitals are isolated. But just because they're isolated...
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Medicare Update for CAHs, Issue 11, November 16, 2011
CMS issued the initial release of the second volume of Medicare Quarterly Compliance Newsletters...
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Medicare Update for CAHs, Issue 11, November 16, 2011
DCS Healthcare posts 36 new issues for medical necessity claims
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Recovery Auditor Report, Issue 22, November 3, 2011
CMS issued the initial release of the second volume of Medicare Quarterly Compliance Newsletters...
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Recovery Auditor Report, Issue 22, November 3, 2011
The American Hospital Association (AHA) will host four members-only conference calls—one for...
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Recovery Auditor Report, Issue 22, November 3, 2011
DCS Healthcare posts 20 new issues for medical necessity claims
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Recovery Auditor Report, Issue 22, November 3, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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Medicare Update for CAHs, Issue 10, November 2, 2011
OIG reviews Medicare outpatient billing for selected drugs at Central Peninsula General Hospital
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Medicare Update for CAHs, Issue 10, November 2, 2011
Consider this scenario: A Medicare patient is brought the emergency department with a diagnosis of...
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Medicare Update for CAHs, Issue 10, November 2, 2011
DCS Healthcare adds 20 new issues for medical necessity claims
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Recovery Auditor Report, Issue 21, October 20, 2011
The following a checklist of best practice techniques when it comes to medical necessity and RAC...
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Recovery Auditor Report, Issue 21, October 20, 2011
CGI posts new issue for DME claims
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Recovery Auditor Report, Issue 21, October 20, 2011
RACs are auditing practices. Learn how to prepare.
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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...
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Medicare Update for CAHs, Issue 9, October 19, 2011
OIG proposes to revise MFCU performance standards
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Medicare Update for CAHs, Issue 9, October 19, 2011
Consider this scenario: A Medicare patient presents to the outpatient surgery department for a...
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Medicare Update for CAHs, Issue 4, October 19, 2011
DCS Healthcare posts four new issues for medical necessity claims
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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...
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Recovery Auditor Report, Issue 20, October 6, 2011
While automated reviews do not require medical record (MR) review, they are the most difficult to...
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Recovery Auditor Report, Issue 20, October 6, 2011
DCS Healthcare posts four new issues for medical necessity claims
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Medicare Update for CAHs, Issue 8, October 5, 2011
CMS released a revised recovery audit contractor (RAC) statement of work (SOW) September 12 that...
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Medicare Update for CAHs, Issue 8, October 5, 2011
This past August, CMS published in the Federal Register the 2012 inpatient prospective payment...
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Medicare Update for CAHs, Issue 8, October 5, 2011
CMS released several MLN Matters articles related to previously-released transmittals.
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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...
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Recovery Auditor Report, Issue 19, September 22, 2011
The Revenue Cycle Institute has released a new white paper, “Principal Diagnosis Selection...
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Recovery Auditor Report, Issue 19, September 22, 2011
CGI posts new issue for professional claims
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Medicare Update for CAHs, Issue 7, September 21, 2011
The October 2011 update of the hospital outpatient prospective payment system (OPPS) contains a bit...
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Medicare Update for CAHs, Issue 7, September 21, 2011
CMS bundled payments initiative
On September 2, HCPro released an article summarizing CMS&rsquo...
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Medicare Update for CAHs, Issue 7, September 21, 2011
Recent RAC activity
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Recovery Auditor Report, Issue 18, September 8, 2011
Editor’s note: This article was excerpted from the new HCPro book, “The RAC Toolkit for...
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Recovery Auditor Report, Issue 18, September 8, 2011
CGI posts new issue for professional claims
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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...
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Medicare Update for CAHs, Issue 6, September 7, 2011
CMS has issued a survey and certification letter regarding telemedicine services in hospitals and...
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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...
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Medicare Update for CAHs, Issue 6, September 7, 2011
CGI posts new issue for professional claims
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Recovery Auditor Report, Issue 17, August 25, 2011
When you understand Medicare's rules and regulations you'll create a solid foundation to protect...
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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...
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Recovery Auditor Report, Issue 17, August 25, 2011
CGI posts three new issues across two categories
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Recovery Auditor Report, Issue 17, August 25, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Medicare Update for CAHs, Issue 5, August 24, 2011
On August 1, CMS issued a transmittal that clarifies payment calculations for anesthesia services...
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Medicare Update for CAHs, Issue 5, August 24, 2011
Recovery audit contractors had previously been responsible for issuing demand letters to providers...
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Medicare Update for CAHs, Issue 5, August 24, 2011
CMS posts telemedicine survey letter
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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...
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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...
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Medicare Update for CAHs, Issue 5, August 24, 2011
CGI posts three new issues across two categories
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Recovery Auditor Report, Issue 16, August 11, 2011
Recovery audit contractors had previously been responsible for issuing demand letters to providers...
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Recovery Auditor Report, Issue 16, August 11, 2011
CMS has released a display copy of the IPPS final rule for fiscal year (FY) 2012.
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Recovery Auditor Report, Issue 16, August 11, 2011
DCS Healthcare posts two new issues for medical necessity claims
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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...
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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...
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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...
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Medicare Update for CAHs, Issue 4, August 10, 2011
DCS Healthcare posts six new issues for medical necessity claims in Maryland.
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Recovery Auditor Report, Issue 15, July 28, 2011
DCS Healthcare posts new issue for DME claims
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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...
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Recovery Auditor Report, Issue 15, July 28, 2011
RAC and other government auditor denials continue to mount up and it’s more important than...
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Medicare Update for CAHs, Issue 3, July 27, 2011
While the 2012 outpatient prospective payment system (OPPS) proposed rule may not contain many...
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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...
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Medicare Update for CAHs, Issue 3, July 27, 2011
Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports became available to CAHs...
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Medicare Update for CAHs, Issue 3, July 27, 2011
Get answers to your questions and Medicare compliance guidance from the experts all year long.
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Recovery Auditor Report, Issue 14, July 14, 2011
CMS released the 2012 outpatient prospective payment system (OPPS) proposed rule July 1.
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Recovery Auditor Report, Issue 14, July 14, 2011
DCS Healthcare posts two new issues for medical necessity claims
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Recovery Auditor Report, Issue 14, July 14, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Medicare Update for CAHs, Issue 2, July 13, 2011
A change to Medicare Claims Processing Manual chapter 4 on “Reporting Hours of...
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Medicare Update for CAHs, Issue 2, July 13, 2011
CMS issues OPPS proposed rule
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Medicare Update for CAHs, Issue 2, July 13, 2011
If an employee of the critical access hospital performs a laboratory service at another facility...
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Recovery Auditor Report, Issue 13, June 30, 2011
In an effort to provide helpful information to providers, CMS released a special edition MedLearn...
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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...
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Recovery Auditor Report, Issue 13, June 30, 2011
DCS Healthcare posts new issue for medical necessity claims
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Recovery Auditor Report, Issue 13, June 30, 2011
A CMS representative gave the audience a reminder about the Section 1011 program, the federal...
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Recovery Auditor Report, Issue 13, June 30, 2011
The Revenue Cycle Institute has released a new white paper, “Medicare’s Annual Wellness...
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Medicare Update for CAHs, Issue 1, June 29, 2011
Inpatient-only procedures are those that CMS determined may only be safely performed on an...
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Medicare Update for CAHs, Issue 1, June 29, 2011
CMS instructs on CAH optional method
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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...
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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...
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Medicare Update for CAHs, Issue 1, June 29, 2011
Here is a summary of recovery audit contractor (RAC) activity from the past two weeks.
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Recovery Auditor Report, Issue 12, June 16, 2011
Editor’s note: This article is the third in a series of three IPPS-related updates.
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Recovery Auditor Report, Issue 12, June 16, 2011
This week CMS released a special edition MLN Matters article reviewing the coverage of percutaneous...
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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...
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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...
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Recovery Auditor Report, Issue 11, June 2, 2011
DCS Healthcare posts five new issues for medical necessity claims
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Recovery Auditor Report, Issue 11, June 2, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 10, May 19, 2011
On April 19, CMS released the inpatient prospective payment system proposed rule for 2012, which...
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Recovery Auditor Report, Issue 10, May 19, 2011
A representative from the Office of Clinical Standards and Quality suggested to the audience that...
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Recovery Auditor Report, Issue 10, May 19, 2011
DCS Healthcare posts three new issues for medical necessity claims
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Recovery Auditor Report, Issue 9, May 5, 2011
CMS released a short but useful Recovery Audit Contractor (RAC) update on its website that reports...
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Recovery Auditor Report, Issue 9, May 5, 2011
CMS and the Medicare Learning Network (MLN) released the third Medicare Quarterly Provider...
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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...
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Recovery Auditor Report, Issue 9, May 5, 2011
On April 27, the physician regulatory issues team (PRIT) discussed the audit of infusion code...
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Recovery Auditor Report, Issue 9, May 5, 2011
The Revenue Cycle Institute has released a new white paper, “RAC Preparedness: Five Ideas for...
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Recovery Auditor Report, Issue 9, May 5, 2011
DCS Healthcare posts 23 new issues for medical necessity claims
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Recovery Auditor Report, Issue 8, April 21, 2011
While reviewing medical records as part of an additional documentation request, a RAC coordinator...
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Recovery Auditor Report, Issue 8, April 21, 2011
DCS Healthcare posts three new issues for medical necessity claims
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Recovery Auditor Report, Issue 8, April 21, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 7, April 7, 2011
Providers familiar with automated claims reviews and complex claims reviews by the recovery audit...
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Recovery Auditor Report, Issue 7, April 7, 2011
DCS Healthcare posts seven new issues for DRG validation claims
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Recovery Auditor Report, Issue 7, April 7, 2011
CMS’ Medicare Learning Network® has released the first in a series of podcasts designed...
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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...
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Recovery Auditor Report, Issue 7, April 7, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 6, March 24, 2011
A Government Accountability Office (GAO) study released March 9 identifies five ways in which GAO...
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Recovery Auditor Report, Issue 6, March 24, 2011
On March 9, CMS released a special edition MLN Matters article that highlights the importance of...
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Recovery Auditor Report, Issue 6, March 24, 2011
Pre-existing condition insurance plans
A representative from the Centers of Consumer Information...
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Recovery Auditor Report, Issue 6, March 24, 2011
Connolly posts six new RAC issues across six categories
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Recovery Auditor Report, Issue 5, March 10, 2011
On February 23, the American Hospital Association (AHA) issued a letter to CMS regarding the...
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Recovery Auditor Report, Issue 5, March 10, 2011
Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to...
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Recovery Auditor Report, Issue 5, March 10, 2011
CMS recently increased the number of medical records that recovery audit contractors (RAC) can...
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Recovery Auditor Report, Issue 5, March 10, 2011
DCS Healthcare posts 29 new issues across two categories
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Recovery Auditor Report, Issue 4, February 24, 2011
As it currently stands, providers respond to documentation requests from review contractors such as...
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Recovery Auditor Report, Issue 4, February 24, 2011
The Revenue Cycle Institute has released a new white paper, “Master the Intricacies of the...
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Recovery Auditor Report, Issue 4, February 24, 2011
CMS and the Medicare Learning Network (MLN) released the second Medicare Quarterly Provider...
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Recovery Auditor Report, Issue 4, February 24, 2011
In response to feedback from the RACs, physicians and their associations, CMS modified the...
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Recovery Auditor Report, Issue 3, February 10, 2011
This past summer when the first Recovery Audit Contractor (RAC) approved the issue “inpatient...
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Recovery Auditor Report, Issue 3, February 10, 2011
CMS has clarified that outpatient procedures that meet preadmission packaging requirements and...
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Recovery Auditor Report, Issue 3, February 10, 2011
A CMS representative began the presentation portion of the call by talking about admissions...
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Recovery Auditor Report, Issue 3, February 10, 2011
CGI removes four DRG validations issues
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Recovery Auditor Report, Issue 3, February 10, 2011
Providers and payers alike have to stay on top of a regulatory environment that is constantly...
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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...
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Recovery Auditor Report, Issue 2, January 27, 2011
Name: Nancy J. Beckley, MS, MBA, CHC
Title: President
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Recovery Auditor Report, Issue 2, January 27, 2011
DCS Healthcare posts seven new issues for DRG validation claims
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Recovery Auditor Report, Issue 2, January 27, 2011
CMS has posted the following frequently asked question:
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Recovery Auditor Report, Issue 2, January 27, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 2, January 26, 2011
How likely would you be to utilize Twitter to follow Revenue Cycle Institute updates?
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Recovery Auditor Report, Issue 1, January 13, 2011
Name: Stacey Levitt, RN, MSN, CPC
Title: Senior Administrative Director of Patient Care...
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Recovery Auditor Report, Issue 1, January 13, 2011
HealthDataInsights adds four new issues for Part A inpatient claims review
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Recovery Auditor Report, Issue 1, January 13, 2011
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 1, January 13, 2011
Hospitals are undoubtedly aware of how a quality clinical documentation improvement program can...
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Recovery Auditor Report, Issue 1, January 13, 2011
Get answers to your questions and Medicare compliance guidance from the experts all year long. Join...
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Recovery Auditor Report, Issue 24, December 30, 2010
Name: William Malm, ND, RN
Title: Healthcare consultant
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Recovery Auditor Report, Issue 24, December 30, 2010
On December 20, the American Hospital Association (AHA) issued a letter to CMS containing comments...
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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...
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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.
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Recovery Auditor Report, Issue 24, December 30, 2010
HealthDataInsights adds two new issues across two categories
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Recovery Auditor Report, Issue 23, December 16, 2010
Continuing in its endeavor to publicize valuable information derived from the RAC demonstration...
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Recovery Auditor Report, Issue 23, December 16, 2010
Name: Yvonne Focke, RN, BSN, MBA
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Recovery Auditor Report, Issue 23, December 16, 2010
EHR Incentive program overview and update
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Recovery Auditor Report, Issue 23, December 16, 2010
CMS released a transmittal on December 10 that will require that a mandatory advanced beneficiary...
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Recovery Auditor Report, Issue 23, December 16, 2010
The Revenue Cycle Institute has released a new white paper, “RAC Preparedness Benchmarking...
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Recovery Auditor Report, Issue 23, December 16, 2010
DCS Healthcare adds 23 issues across four categories
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Recovery Auditor Report, Issue 23, December 16, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 22, December 2, 2010
Name: Elizabeth Lamkin
Title: President
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Recovery Auditor Report, Issue 22, December 2, 2010
The Revenue Cycle Institute recently had a brief conversation with Karen Sagen, managed care leader...
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Recovery Auditor Report, Issue 22, December 2, 2010
On November 10, CMS-in response to feedback from the RACs, providers/suppliers and their...
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Recovery Auditor Report, Issue 22, December 2, 2010
CGI adds new RAC issue in two separate categories
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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...
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Recovery Auditor Report, Issue 21, November 11, 2010
CMS released the long-anticipated proposed rule for Medicaid recovery audit contractors (RACs...
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Recovery Auditor Report, Issue 21, November 11, 2010
Name: Nancy Hirschl, B.S., CCS
Title: President
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Recovery Auditor Report, Issue 21, November 11, 2010
In late September, CMS published an MLN Matters article entitled "Recovery Audit Contractor...
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Recovery Auditor Report, Issue 21, November 11, 2010
DCS Healthcare posts new issue for DRG validation claims
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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...
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Recovery Auditor Report, Issue 20, October 28, 2010
On October 19, CMS—in response to feedback from the RACs, providers/suppliers and their...
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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...
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Recovery Auditor Report, Issue 20, October 28, 2010
CGI adds new issue for DME claims
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Recovery Auditor Report, Issue 19, October 14, 2010
CMS and the Medicare Learning Network (MLN) recently released the Medicare Quarterly Provider...
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Recovery Auditor Report, Issue 19, October 14, 2010
Name: Donna Wilson, RHIA, CCS
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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...
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Recovery Auditor Report, Issue 19, October 14, 2010
Medical devices, radiation therapy quality and safety, and an expanded focus on the three- and...
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Recovery Auditor Report, Issue 19, October 14, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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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...
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Recovery Auditor Report, Issue 18, September 30, 2010
In an effort to propagate useful information on RAC high-dollar improper payment vulnerabilities...
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Recovery Auditor Report, Issue 18, September 30, 2010
After much anticipation, they’ve finally arrived. With the recent CMS approval of issues for...
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Recovery Auditor Report, Issue 18, September 30, 2010
DCS Healthcare posts new issue
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Recovery Auditor Report, Issue 18, September 30, 2010
In the October 2010 update of the hospital outpatient prospective payment system (OPPS), CMS...
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Recovery Auditor Report, Issue 18, September 30, 2010
Hospital quality update
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Recovery Auditor Report, Issue 18, September 30, 2010
The waiting is over. CMS has approved medical necessity RAC issues, creating a new challenge for...
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Recovery Auditor Report, Issue 17, September 16, 2010
CMS released through one of their provider listservs last week revised guidance on reporting the...
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Recovery Auditor Report, Issue 17, September 16, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 17, September 16, 2010
Help us to understand your RAC experience.
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Recovery Auditor Report, Issue 17, September 16, 2010
Question: Are academic programs that practice more evidence-based medicine at a lower risk of audit...
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Recovery Auditor Report, Issue 16, September 2, 2010
Let’s face it; RACs are an albatross around the neck of susceptible providers.
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Recovery Auditor Report, Issue 16, September 2, 2010
According to a July HCPro survey of approximately 500 healthcare providers, 56% have already...
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Recovery Auditor Report, Issue 16, September 2, 2010
DCS Healthcare posts two new RAC issues
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Recovery Auditor Report, Issue 16, September 2, 2010
Diversified Collection Services (DCS) began its affiliation with the RAC program when CMS awarded...
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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...
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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...
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Recovery Auditor Report, Issue 15, August 19, 2010
Inpatient rehabilitation facilities (IRF) were the recent target of two OIG reviews.
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Recovery Auditor Report, Issue 15, August 19, 2010
DCS Healthcare posts 10 new RAC issues for non-medical necessity inpatient claims
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Recovery Auditor Report, Issue 15, August 19, 2010
The Revenue Cycle Institute has released a new white paper, "What Every CDI Program Needs to...
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Recovery Auditor Report, Issue 16, August 5, 2010
Recent approval of a Region C RAC issue for inpatient hospital claims review has initiated...
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Recovery Auditor Report, Issue 16, August 5, 2010
The provider community is reporting a new trend of late: RACs are denying post-discharge queries...
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Recovery Auditor Report, Issue 16, August 5, 2010
Connolly adds nine new RAC issues across three categories
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Recovery Auditor Report, Issue 16, August 5, 2010
The three-day payment window rule (sometimes incorrectly referred to as the 72-hour rule) continues...
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Recovery Auditor Report, Issue 16, August 5, 2010
On July 30, CMS issued the inpatient prospective payment system (IPPS) final rule
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Recovery Auditor Report, Issue 16, August 5, 2010
CMS posts new RAC questions and answers
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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...
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Recovery Auditor Report, Issue 15, July 22, 2010
The Revenue Cycle Institute has become aware of published information that might be misleading or...
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Recovery Auditor Report, Issue 15, July 22, 2010
Each regional recovery audit contractor (RAC) differs in its approach when it comes to dealing with...
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Recovery Auditor Report, Issue 15, July 22, 2010
On July 2, CMS published the OPPS Proposed Rule for 2011 ahead of anticipated timeframes.
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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...
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Recovery Auditor Report, Issue 14, July 8, 2010
Hospitals clamoring for guidance from CMS about the three-day payment window must now grapple with...
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Recovery Auditor Report, Issue 14, July 8, 2010
The Revenue Cycle Institute has released a new white paper, “Critical Access Hospitals...
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Recovery Auditor Report, Issue 14, July 8, 2010
Each month the Revenue Cycle Institute publishes a free sample tool or form for readers.
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Recovery Auditor Report, Issue 13, June 24, 2010
DCS Healthcare posts 23 new RAC issues
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Recovery Auditor Report, Issue 13, June 24, 2010
In the increasingly stressful realm of RAC coordination the last thing providers need is additional...
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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...
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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...
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Recovery Auditor Report, Issue 12, June 10, 2010
With the growing number of CMS-approved RAC issues and the impending medical necessity audits on...
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Recovery Auditor Report, Issue 12, June 10, 2010
Be part of a comprehensive assessment of the Recovery Audit Contractor (RAC) program and how...
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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...
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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...
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Recovery Auditor Report, Issue 11, May 27, 2010
A recently released transmittal from CMS adds direct language to the Medicare Program Integrity...
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Recovery Auditor Report, Issue 11, May 27, 2010
Be part of a comprehensive assessment of the Recovery Audit Contractor (RAC) program and how...
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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...
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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...
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Recovery Auditor Report, Issue 10, May 13, 2010
A recent transmittal released by CMS implemented a number of changes to the Medicare Financial...
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Recovery Auditor Report, Issue 10, May 13, 2010
CMS updates MAC business requirements regarding RACs
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Recovery Auditor Report, Issue 10, May 13, 2010
Providers and payers alike have to stay on top of a regulatory environment that is constantly...
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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...
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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...
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Recovery Auditor Report, Issue 4, February 18, 2010
Get answers to your questions and Medicare compliance guidance from the experts all year long. Join...
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Recovery Auditor Report, Issue 1, January 7, 2010
Having the right process—and people—in place can help ensure your hospital consistently...
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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...
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Recovery Auditor Report, Issue 24, December 10, 2009
Hold on to your stethoscopes, the Senate Healthcare Reform Bill is expanding the RAC program...
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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...
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Recovery Auditor Report, Issue 24, November 25, 2009
Budgets are tight, but it seems that many healthcare providers are aware that setting aside...
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Recovery Auditor Report, Issue 23, November 12, 2009
HealthDataInsights (HDI) has added multiple new RAC issues to their CMS-approved list in late...
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Recovery Auditor Report, Issue 23, November 12, 2009
Providers who believe their RAC denials will be limited to 200 every 45 days (corresponding with...
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Recovery Auditor Report, Issue 23, November 12, 2009
The Comprehensive Error Rate Testing (CERT) Hospital Payment Monitoring Program is one of the ways...
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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...
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Recovery Auditor Report, Issue 22, October 29, 2009
On October 15 CMS released an FAQ on the appearance of code N432 on remittance advice.
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Recovery Auditor Report, Issue 22, October 29, 2009
The high number of claims determinations appealed was a measure of dissatisfaction with the RAC...
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Recovery Auditor Report, Issue 22, October 29, 2009
There’s no question that audit activity is escalating and the healthcare provider community...
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Recovery Auditor Report, Issue 21, October 15, 2009
As of September 18, all four RACs were conducting automated audits, according to an October 6...
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Recovery Auditor Report, Issue 21, October 15, 2009
HealthDataInsights (HDI) has announced two new issues for region D.
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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...
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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...
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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...
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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...
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Recovery Auditor Report, Issue 21, October 15, 2009
The Revenue Cycle Institute has released a new White Paper, “Inpatient or Outpatient Only...
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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...
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Recovery Auditor Report, Issue 20, October 1, 2009
CMS released the following new RAC FAQ September 25: How long is the Recovery Audit Contractor...
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Recovery Auditor Report, Issue 20, October 1, 2009
On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...
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Recovery Auditor Report, Issue 20, October 1, 2009
At this point, thanks to a three-year demonstration project and a plethora of available information...
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Recovery Auditor Report, Issue 20, October 1, 2009
The Revenue Cycle Institute has released a new White Paper, “Sepsis and Septicemia: Clear Up...
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Recovery Auditor Report, Issue 19, September 17, 2009
Q: Several RACs are looking for once in a lifetime procedure coding errors. Wouldn’t...
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Recovery Auditor Report, Issue 19, September 17, 2009
CMS released on September 11 transmittal 302, which outlines the authority RACs, MACs, and other...
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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...
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Patient Access Weekly Advisor, Issue 36, September 9, 2009
Might there be a little friendly competition between RACs and MACs?
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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...
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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...
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Recovery Auditor Report, Issue 18, September 3, 2009
Connolly, the Region C RAC, has been approved to audit Durable Medical Equipment (DME) providers...
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Recovery Auditor Report, Issue 18, September 3, 2009
Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida, including...
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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...
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Recovery Auditor Report, Issue 18, September 3, 2009
CMS updated the three RAC FAQ on August 26.
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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...
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HCPRO Website, Issue 1, August 26, 2009
CGI Federal, the RAC for Region B, has posted its first set of issues eligible for RAC audits in...
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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...
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Recovery Auditor Report, Issue 17, August 20, 2009
HealthDataInsights, Inc. (HDI), launched its new RAC Web site, and posted the first set of issues...
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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...
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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.
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HCPRO Website, Issue 1, August 13, 2009
HealthDataInsights, Inc. (HDI), launched its new RAC Web site, and posted the first set of issues...
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Recovery Auditor Report, Issue 16, August 6, 2009
Q: Can we appeal a RAC automated audit that results in a denial?
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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...
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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...
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Recovery Auditor Report, Issue 15, July 23, 2009
The Revenue Cycle Institute has released a new white paper, “Present on Admission: Accurate...
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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...
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Recovery Auditor Report, Issue 14, July 9, 2009
When it comes to surviving RACs, effective physician advisors can be a “saving grace,&rdquo...
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Recovery Auditor Report, Issue 14, July 9, 2009
Take advantage of a handy tool to ensure that your physicians don’t overlook Initial...
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Recovery Auditor Report, Issue 13, June 25, 2009
On June 12, CMS updated the Medicare Financial Management Manual with information pertaining to the...
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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...
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Recovery Auditor Report, Issue 13, June 25, 2009
Q. Our Midwestern physician practice that has more than 30 physicians. Are physician offices...
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Recovery Auditor Report, Issue 13, June 25, 2009
When planning for RAC record requests, HIM directors should ask several essential questions.
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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...
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Recovery Auditor Report, Issue 12, June 11, 2009
CMS released 14 new RAC FAQ June 3.
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Recovery Auditor Report, Issue 12, June 11, 2009
CMS anticipates RAC automated reviews will begin in late June and July, according to Marie Casey...
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Recovery Auditor Report, Issue 12, June 11, 2009
In the July 2009 quarterly updates, CMS revised portions of both the Claims Processing Manual and...
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Recovery Auditor Report, Issue 12, June 11, 2009
Help ensure your facility properly obtains ABNs from patients for Medicare noncovered services with...
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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...
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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...
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Recovery Auditor Report, Issue 11, May 28, 2009
Coders should arm themselves with as much wound care and coding knowledge as possible to prepare...
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Recovery Auditor Report, Issue 11, May 28, 2009
Q: Are the Medicare Advantage plans included in RAC audits?
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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...
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Recovery Auditor Report, Issue 10, May 14, 2009
The “Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role...
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Recovery Auditor Report, Issue 9, April 30, 2009
CMS has posted the recording, transcript and other related information from the April 8 RAC Open...
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Recovery Auditor Report, Issue 9, April 30, 2009
The American Hospital Association (AHA) has shared what it knows about RACs via a Member...
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Recovery Auditor Report, Issue 9, April 30, 2009
Q: We have been trying to calculate the outpatient hospital medical record request limits...
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Recovery Auditor Report, Issue 9, April 30, 2009
The HCPro Revenue Cycle Institute has just released two new complimentary White Papers.
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Recovery Auditor Report, Issue 9, April 30, 2009
Recordings of the following “Recovery Audit Contractor Defense: A RAC Readiness Summit&rdquo...
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Recovery Auditor Report, Issue 9, April 30, 2009
Are RACs violating CMS’ own rules? Palomar Medical Center in Escondido, CA believes they are.
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Recovery Auditor Report, Issue 8, April 16, 2009
CMS has updated its RAC education and outreach schedule. The schedule contains new information...
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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...
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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...
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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...
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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...
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Recovery Auditor Report, Issue 7, April 2, 2009
The HCPro Revenue Cycle Institute released a new White paper on injection and infusion coding and...
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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...
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Recovery Auditor Report, Issue 7, April 2, 2009
CMS has recently announced the first round of provider information and outreach sessions on RACs...
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Recovery Auditor Report, Issue 7, April 2, 2009
If you’ve experienced RACs at your facility during the demonstration project, we want to hear...
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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...
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Recovery Auditor Report, Issue 6, March 19, 2009
On March 6 CMS issued Transmittal 148 rescinding and replacing previous instruction regarding the...
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Recovery Auditor Report, Issue 6, March 19, 2009
Q: A provider does three different procedures in three different days. Is this acceptable? Are RACs...
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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...
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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!
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Recovery Auditor Report, Issue 5, March 5, 2009
RACs cannot randomly select or target a claim “solely because it is a high-dollar...
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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...
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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.
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Recovery Auditor Report, Issue 4, February 19, 2009
Editor’s note: Answer all the questions correctly and submit your answer on or before...
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Recovery Auditor Report, Issue 4, February 19, 2009
When coding for outpatient procedures, coders should base the patient’s diagnosis on his or...
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Recovery Auditor Report, Issue 4, February 19, 2009
The announcement from CMS officially kicks the RAC program back into gear. Hospitals and providers...
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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...
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Patient Access Weekly Advisor, Issue 5, February 11, 2009
Use these Medicare Secondary Payer tips in order to remain compliant and obtain full reimbursement.
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HCPRO Website, Issue 4, February 6, 2009
CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...
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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...
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Recovery Auditor Report, Issue 3, February 5, 2009
Most inpatient coders are accustomed to seeing “probable,” “suspected,&rdquo...
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Recovery Auditor Report, Issue 3, February 5, 2009
We’ve added several new features to our Revenue Cycle Institute Web site...
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Patient Access Weekly Advisor, Issue 4, February 3, 2009
Mandatory use of the new ABN form will be here before you know it.
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Recovery Auditor Report, Issue 2, January 22, 2009
Medical necessity is complex because there is debate regarding what constitutes...
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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.
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Patient Access Weekly Advisor, Issue 2, January 21, 2009
Inauguration speeches are all about promises. Dunn Memorial Hospital’s patient access team...
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Recovery Auditor Report, Issue 11, January 8, 2009
On January 6 CMS released an update to its three-year RAC demonstration program report previously...
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Recovery Auditor Report, Issue 10, December 24, 2008
Although coding denials did not remain the focus by the end of the demonstration project, and...
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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...
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Recovery Auditor Report, Issue 10, December 24, 2008
Are you questioning a claim reviewed by a RAC during the demonstration project? If so, CMS...
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Recovery Auditor Report, Issue 9, December 11, 2008
CMS posted new and updated RAC FAQs on the CMS Web site on December 2.
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Recovery Auditor Report, Issue 9, December 11, 2008
If documentation in the medical record is not accurate, complete and timely patient care can be...
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Recovery Auditor Report, Issue 9, December 11, 2008
In Transmittal 144, released November 28, CMS revised its Monthly Statistical Report on...
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Patient Access Weekly Advisor, Issue 78, November 26, 2008
CMS tweaked its transmittal updating the Medicare deductible, coinsurance, and premium rates for...
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Patient Access Weekly Advisor, Issue 77, November 19, 2008
Revenue cycle managers must continue to prepare their staff members to help confused patients with...
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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...
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Recovery Auditor Report, Issue 7, November 13, 2008
The Social Security Administration is seeking comments on a proposed rule that will attempt to...
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Recovery Auditor Report, Issue 6, October 30, 2008
Question: Under what circumstances can a RAC make a finding that an overpayment or underpayment...
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Patient Access Weekly Advisor, Issue 71, October 8, 2008
Federal regulators are investigating charges to Medicare in the Miami area, where government costs...
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Patient Access Weekly Advisor, Issue 69, September 24, 2008
Check out these MSP tips provided by Stephanie Smithson, CHAM, patient access manager at Dunn...
