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Tag: Recovery Auditor

New Rules for Therapy Appeals

August 29, 2015 1 Comment
New Rules for Therapy Appeals

CMS has issued guidance for reviews at the redetermination and reconsideration levels resulting in new rules applicable for therapy appeals.  Given that providers are now receiving the results of manual medical review of therapy over the $3700 threshold therapy providers have an interest in appealing unfavorable decisions, particularly for institutional providers billing on the UB04 claim […]

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RAC Therapy Reviews Underway: 2014 Therapy Claims

February 26, 2015 3 Comments
RAC Therapy Reviews Underway: 2014 Therapy Claims

RAC therapy reviews are underway as CMS paved the way for manual medical review of therapy claims over the $3700 threshold by the Recovery Auditors (RACs). Effective January 16th CMS provided a contract addendum to the current (outgoing) RACs in all 4 regions to begin a review of therapy claims over $3700 submitted between March […]

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$3700 Therapy Threshold RAC Reviews

December 4, 2014 1 Comment
$3700 Therapy Threshold RAC Reviews

$3700 therapy threshold RAC reviews have resumed even though the larger RAC program has been “paused”.  Therapy over the $3700 per beneficiary thresholds ($3700 for PT & SLP combined, another $3700 for OT) is mandatorily reviewed for medical necessity.  CMS has assigned the review task to the RACs.  According to information provided by CMS to the […]

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RAC Restart Facts…(Not Rumors)..So Far

August 12, 2014 2 Comments
RAC Restart Facts…(Not Rumors)..So Far

The therapy community is abuzz with all the rumors and misinformation on the RAC restart facts. So far there are a few things that we do know.  We know that CMS wrote letters to members of Congress on Friday August 1st announcing their intention to have a limited restart to the “paused” RAC program. We also know […]

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CMS to Restart Some RAC Reviews

August 4, 2014 3 Comments
CMS to Restart Some RAC Reviews

CMS announced today that it is initiating contract modification with the current Recovery Auditors in Regions A, B, C and D to restart reviews of a limited number of issues.  While CMS had previously announced that new Recovery Auditor (RAC) contracts would be announced for Regions 1-5 no later than August 15th their announcement today […]

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Medicare Audits

July 10, 2014 0 Comments
Medicare Audits

Have you had a Medicare audit?  Medicare has a number of program integrity contractors that can pry into your records, while you are sleeping, as well as during the day for an onsite “surprise ” visit.   Most likely if you have had a Medicare audit, it was most likely a medical review of a claim […]

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RAC Updates

July 7, 2014 0 Comments
RAC Updates

RAC ‘n Rehab Series©~  Since the RAC “pause” in activities at the end of February have you been enjoying your summer, sitting at the beach and perhaps wondering about RAC updates?  CMS had previously announced that the RAC contracts would be awarded beginning in May.  The Region 5 contract for Home Health, Hospice and DME was […]

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RAC Work Pause and Therapy Manual Medical Review

February 24, 2014 1 Comment
RAC Work Pause and Therapy Manual Medical Review

The CMS RAC Work pause of the Recovery Auditor (RAC) program will provide some work load relief for outpatient therapy providers in the short run, but in the long run 100% of therapy claims over the $3700 thresholds will be reviewed.  So what does this mean for therapy providers?  Check your mail, if you are […]

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RAC Audit Stoppage Not Likely to Affect Therapy ADR

February 20, 2014 2 Comments
RAC Audit Stoppage Not Likely to Affect Therapy ADR

CMS announced this week that the Recovery Audit program (RACs) would pause for a period of time so that the current ADR requests can process through the RAC reviews.  RAC audit stoppage is not likely to affect therapy ADRs.  In what might have been a false sense of “freedom” rehab providers reading RAC Monitor’s special […]

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Appealing Medicare Denials – 5 Things You Must Know

February 11, 2014 0 Comments
Appealing Medicare Denials – 5 Things You Must Know

Appealing Medicare denials is likely to be a reality for all outpatient therapy providers this year. Therapy over the $3700 cap is subject to 100% mandatory medical review by the Recovery Auditors (RACs) through 3/31/2013.  In fact those reviews, if not favorable, will first frustrate you, then possible anger you, then compel you to file an […]

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