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CMS Announces New Program Integrity Initiatives: More Recoupment Efforts Will be Forthcoming

November 15, 2011 0 Comments
CMS Announces New Program Integrity Initiatives:  More Recoupment Efforts Will be Forthcoming

CMS announced today that  effective January 1, 2012 they will conduct demonstration projects designed to strengthen Medicare by aiming at eliminating fraud, waste, and abuse.   Three programs were announced:  Recovery Audit Prepayment Review: The Recovery Audit Prepayment Review demonstration will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the […]

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CMS New Electronic Submission of Medical Records: esMD

September 29, 2011 4 Comments
CMS New Electronic Submission of Medical Records: esMD

On a recent MonitorMonday podcast sponsored by RACMonitor.com, Melanie Combs-Dyer, Deputy Director of the Compliance Group, CMS Office of Financial Management provided listeners with how the roll out of esMD will take place.  Providers will now be able to submit medical records that have been requested by various contractor electonically, rather than via fax, mail […]

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RAC Talk with HCPro

February 10, 2011 0 Comments
RAC Talk with HCPro

Nancy Beckley was interviewed recently by James Carroll at HCPro Revenue Cycyle Institute’s Blog for he thoughts on the Recovery Audit Contractor Program and what’s ahead for providers this coming year.

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RAC Untimed Codes Issues Misinterpreted by Region A RAC

February 4, 2011 0 Comments
RAC Untimed Codes Issues Misinterpreted by Region A RAC

Pennsylvania providers are reporting problems with therapy untimed codes that are subject to RAC automated reviews.  While CMS policy indicates that therapy untimed codes may only be billed in increments of one unit per visit, the RACs are interpreting that two untimed codes billed on the same day are apparantly equivalent to two units of one untimed codes.  This […]

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Comprehensive Outpatient Rehabilitation Facilities (CORFs)

May 20, 2010 2 Comments
Comprehensive Outpatient Rehabilitation Facilities (CORFs)

In a recent RACMonitor.com article on The Curious Case of the CORF   the CORF was described as an “orphan” program that had conflicting regulatory advice for providers in recent years.  The Conditions of Participation, the State Operations Manual Interpretive Guidelines, and various instructions from the Medicare Contractors (fiscal intermediaries and MACs) put the provider at […]

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CMS Posts RAC “101” Informational Video on YouTube

April 13, 2010 0 Comments
CMS Posts RAC “101” Informational Video on YouTube

CMS has recently announced a new round of RAC informational sessions for providers.  The video features the slide show used in the original fall RAC informational sessions along with commentary by Commander Marie Casey.  This video production is one of many that have been posted by CMS/HHS on YouTube.  This video is being released as […]

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Florida Rehab Providers Now Receiving RAC Demand Letters

November 10, 2009 1 Comment
Florida Rehab Providers Now Receiving RAC Demand Letters

Florida therapy providers are beginning to report the receipt of official “demand letters” from Connolly Healthcare, the Region C Recovery Audit Contractor.   A Florida therapy provider, who asked not to be identified, has reported receiving several demand letters related to the billing of speech therapy untimed codes in units greater than one.  This provider has multiple […]

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RAC Region B Adds New Issues – Rehab Included

October 15, 2009 0 Comments
RAC Region B Adds New Issues – Rehab Included

CGI, the Region B Recovery Audit Contractor has added several new CMS approved issues.  The issue of untimed codes for therapy is now approved for Illinois, Indiana, Kentuckhy, Michigan, Minnesota, Ohio and Wisconsin.  The issue was approved on 9/30/2009 and covers services from 10/1/2007 forward.  According to CGI: Untimed Codes – CPT codes (excluding modifiers KX, […]

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CMS Issues Final Rule on Recoupment – Impacts RACs

September 23, 2009 0 Comments
CMS Issues Final Rule on Recoupment – Impacts RACs

CMS Issued New “Final” Recouping Regulation, at 42 CFR 405.370, 405.378, 405.379.  The effect of this rule is to shorten providers decision making time in making appeals on overpayment demands.    Recouping involves a Medicare Contractor holding back reimbursement to offset monies that a provider is deemed to owe to the Medicare Program.  According to CMS […]

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Does Your RAC Know How to Contact You?

September 21, 2009 0 Comments
Does Your RAC Know How to Contact You?

With the Region A RAC adding three issues over this past weekend, including a new issue of Pharmacy Supply and Dispensing Fees, all four of the Recovery Audit Contractors are now on board with automated review underway.  During the RAC roll-out process, often referred to as ‘town hall meetings” CMS as well as the four […]

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