For two years, we have been reporting that the giant collection agencies that won government contracts to recover Medicare overpayments were entirely focused on lucrative bounties available when they audit hospitals and large physician practices. That may be changing. Our periodic search for the word “home” on the web sites of the four collection agencies acting as Recovery Audit Contractors (RAC) got a hit for the first time last week. In this article: we post the web sites of all four RACs
we identify each RAC’s covered states
we reprint the three newly approved audit issues that mention home care.
Recovery Audit Contractors are revealing early signs that they may soon take an interest in home care. What can we learn from the way they have been treating hospitals? A new survey indicates we can learn a lot. Nearly three quarters of hospitals believe the RAC program does reduce fraud and errors. At the same time, 60% of them find the audit process unfair. Most significant, nearly one quarter of them have had to hire additional staff to handle auditor documentation demands and short timelines.
“More frequently than chance would dictate, denial letters dispose of just enough visits to kick a full-pay episode down to a LUPA. When there were seven visits, they deny three; when there were five visits, they deny one. Rarely if ever do agencies see a seven- or ten-visit episode reduced to five.”
If home health care providers sometimes feel that government agencies treat the industry like a pre-ball Cinderella when it comes to payment rates, a new report from the Office of Inspector General (OIG) will not make them feel any better. Though CMS continues to look for reasons to reduce payment rates to home care agencies, […]
The Patient Protection and Affordable Care Act (aka the health care reform bill currently under consideration by the Senate) has implications for the RACs. Of most relevance in this 2074 page bill is Section 6411 which seeks to expand RACs to Medicare Parts C and D by 12/31/2010. The RAC program would also be expanded […]
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.
Home care and hospice can breathe easy for a while, but only about this one issue. Recovery Audit Contractors (RAC) are limited in the issues they can use to recoup funds from Medicare providers. It is important that all providers learn what those issues are and keep themselves updated as they change. Initially, RACs may […]
Connolly Healthcare, the RAC for Region C, is again leading the RAC pack in getting CMS approval for issues to review. This week Connolly posted two issues for DME providers. Click here if you are interested in seeing the description of these issues. Diversified Collection Services, the RAC for Region A, continues to be the only RAC […]
There is still not too much activity at the RAC Forum and there may not be until RACs begin targeting hospices. Nevertheless, we have added a new topic/category to the RAC Forum that we hope will be helpful. It is called “Claim Denial Reasons.” At the moment we do not know what issues the RACs will […]
by Aricka Flowers HHNS staff writer As the Recovery Audit Contractor program’s January 1, 2010 implementation date nears, this new challenge to healthcare provider revenue looms as an imminent reality. Many providers look at the few remaining weeks between now and 2010 and are racked with fear and anxiety. Is the trepidation warranted? Not all […]
