Don’t Just Pay the RAC


Medicare Recovery Audit Contractors (RACs) mine data using automated systems to detect and recover improper Medicare payments.  RAC audits pick up billing and coding errors and deny claims based on those errors.  In many instances, the service was provided and was billable.  In some cases, the coding error makes no difference in reimbursement, sometimes reimbursement should be higher, sometimes lower, but still reimbursable, under some code. In some cases, the RAC’s automated systems deny claims that were properly billed, because of software coding flaws.  RAC auditors don’t correct billing errors, they just take the money back.

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Expansion of CMS Never Events: They’re Not Just For Medicare Or Just For Hospitals Anymore


Expansion of CMS Never Events:  They’re Not Just For Medicare Or Just For Hospitals Anymore

In 2005 when “Never Events” were proposed for hospitals through the Deficit Reduction Act, no one knew what the overall effect would be on hospitals or patient care.  CMS later developed these and implemented these Never Events under the authority of the DRA to prevent Medicare payment to hospitals for certain “never events” or hospital acquired conditions (HACs) which were conditions that were high volume, involved higher payment, and which could be easily preventable.  Now, hospitals and other health care providers have to worry about Never Events in the Medicaid space. 

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Duane Morris Health Law

Reporting legal developments in the healthcare industry and the latest on the implementation of
the Healthcare Reform Act impacting providers, employers and physicians.

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