“Clear as M.U.D.” presents actual stories of payment denials that appear on the surface to be difficult to explain. Fiscal Intermediaries and QICs are supposed to deny or recoup payments when a service to a patient appears to be a Medically Unbelievable Claim. On occasion, this can result in what we call a Medically Unbelievable […]
We may be rightly accused of harping on this theme a lot but it is important enough to revisit from time to time. Beware of those who would scare you into focusing on the government’s future revenue protection program, the Recovery Audit Contractors (RAC), so much that you lose sight of current programs. Some of […]
Keep an eye on the progress of Senate Bill 1959, introduced on October 28 by Senator Ted Kaufman (D-Del.), (along with co-sponsoring Senators Patrick Leahy, Arlen Specter, Herb Kohl, Chuck Schumer, and Amy Klobuchar), especially if you operate a Medicare home care agency in Miami-Dade, Houston, Detroit or Los Angeles. The Health Care Fraud Enforcement […]
Analysis by Michael McGowan Shortcuts are popular and frequently useful. They can also be misleading and dangerous. In the world of payment denials and appeals where I spend most of my time, a popular new shortcut is the audit tool. I am seriously concerned about those who might rely too heavily on such checklists and […]
It is becoming apparent that certain cities have been targeted by recently stepped-up CMS efforts to protect the Medicare trust fund from inadvertent or fraudulent overpayments. Wise administrators and owners in non-targeted regions are watching what is going on in Miami, Houston and Los Angeles carefully, learning from the experiences of their colleagues there. Here […]
As we have previously reported, RAC auditors are prohibited from investigating overpayments arising from any clinical or administrative issues that were not on the table during the 3-year RAC demonstration project. One by one, the collection agencies that hold RAC contracts have been adding to the list of issues, applying for and getting CMS approval for issues not addressed during the demonstration. From time to time, we will provide updated lists of approved issues. As you will see from this week’s list, RACs are not looking at home care yet.
