Tag: recovery auditors

Coming Soon: Improved CMS HIPAA Website

The Centers for Medicare & Medicaid Services (CMS) will soon launch a series of updates for the HIPAA Administrative Simplification category of the CMS website. The updated pages will feature streamlined content and easier navigation. Please note that the new website will launch with a new URL, so you will need to update any bookmarks that you […]

CMS cutting-edge technology identifies & prevents $820 million in improper Medicare payments in first three years

After three years of operations, the Centers for Medicare & Medicaid Services (CMS) reported that the agency’s advanced analytics system, called the Fraud Prevention System, identified or prevented $820 million in inappropriate payments in the program’s first three years. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for […]

Senate Finance Committee holds hearing on Medicare appeals system

On April 28, 2015, The Senate Finance Committee held a hearing about the Medicare appeal problems, focusing on the immense backlog at the ALJ level.  The committee members considered ways to fix problems at the center of the appeals backlog. However, the current proposals don’t work; they would further restrict access to meaningful reviews. Current […]

Medicaid Fraud Control Units recover over $10 million in 2013

Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in FY 2013, according to an annual report issued Friday. Practically every state operates a fraud control unit, and the report from the Department of Health and Human Services Office of the Inspector General compiled results from all of these units. The investigations included: Allegations of […]

OIG releases new report on RAC program and improper payments

On September 3, the Office of Inspector General (OIG) released a report titled, “Medicare Recovery Audit Contractors and CMS’s Actions To Address Improper Payments, Referrals of Potential Fraud, and Performance.” The report found that in 2010 and 2011, Recovery Audit Contractors (RAC) identified half of all claims they reviewed as having resulted in improper payments […]

HCPro’s 2013 Recovery Auditor Benchmarking Report

This year’s Recovery Auditor Benchmarking Report surveyed 325 respondents, representing both small and large hospitals, from all four Recovery Auditor regions. It may not come as a huge surprise to many that the mean theme of this year’s survey is the expanding state of the Recovery Auditors, and the fact that they continue to gain speed and extend their reach.

This theme becomes apparent almost immediately as we look at the percentage of providers that have had recoupments from automated reviews—it has risen by 14% this year. In addition, the amount of providers that have seen record requests for complex or semi-automated reviews has gone from 82% to 91%. This may not be shocking, as CMS continues to approve more issues and the scope of the RAs continues to expand, but it highlights the fact that the audits are ever-changing and will force providers to stay on their toes.

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Clarifying the Recovery Auditor-related provisions in the American Taxpayer Relief Act of 2012

by Ralph Wuebker, MD, MBA, Chief Medical Officer, Executive Health Resources There has been some confusion surrounding a possible Recovery Auditor-related provision in the American Taxpayer Relief Act of 2012, also known as the Fiscal Cliff deal. Specifically, the question of whether the Recovery Auditor look-back period was extended from three to five years was […]