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

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.

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 . . . → Read More: RAC Untimed Codes Issues Misinterpreted by Region A RAC

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 . . . → Read More: Comprehensive Outpatient Rehabilitation Facilities (CORFs)

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 . . . → Read More: CMS Posts RAC “101″ Informational Video on YouTube

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 . . . → Read More: Florida Rehab Providers Now Receiving RAC Demand Letters