The latest shot in the war between hospitals and RACs has been fired. The American Hospital Association (AHA) and four hospital systems brought a lawsuit against the Department of Health and Human Services (HHS), alleging that the government’s recovery audit contractor (RAC) program improperly demands …
The ZPICs are Here! Is Your Organization Ready?
April 24, 2012 Leave a Comment
Effective April 24th, 2012, Cahaba Safeguard Administrators, LLC, the Zone Program Integrity Contractor (ZPIC) for Zone 3, is fully operational. Zone 3 includes the following states: Minnesota, Indiana, Michigan, Illinois, Ohio, Wisconsin and Kentucky. Implementation of a ZPIC contractor in Zone 3 was delayed …
CMS Launches Medicaid RAC Website
March 3, 2011 Leave a Comment
The Centers for Medicare & Medicaid Services (CMS) launched a new website entitled “State Medicaid RAC’s At-A-Glance.” The website contains a map of the United States, and is designed to track implementation of the Medicaid Recovery Audit Contractor (RAC) program in each state. By hovering the cursor …
Proposed Rule Implements the Medicaid RAC Program
November 19, 2010 Leave a Comment
CMS issued a proposed rule on November 10, 2010 implementing the Medicaid Recovery Audit Contractor (RAC) program required under Section 6411 of the Patient Protection and Affordable Care Act. States are required to establish Medicaid RAC programs by December 31, 2010, but CMS proposes these programs do not need …
CMS Issues New Compliance Tool for Providers
November 5, 2010 Leave a Comment
In October, CMS posted its first issue of a new educational newsletter called the “Medicare Quarterly Provider Compliance Newsletter.” This newsletter is intended to help physicians, providers, and suppliers understand how to avoid certain billing errors and other improper activities. The newsletter will …
RAC Medical Necessity Denials: Asking for What Is Fair
October 21, 2010 Leave a Comment
Last week we wrote about the impending medical necessity denials from Medicare’s Recovery Audit Contractors (RACs). If an inpatient admission was not medically necessary, we talked about the potential application of the limitation of liability defense. Even if that is not successful, another alternative argument …