News & Analysis as of

Centers for Medicare & Medicaid Services (CMS) Recovery Audit

Arnall Golden Gregory LLP

“Should Auld Acquaintance Be Forgot” - Performant to Initiate Home Health, Hospice, and DME Audits in 2017

The final quarter of 2016 ended with the Centers for Medicare & Medicaid Services (CMS) announcing Performant Recovery, Inc. (Performant) as the new national Recovery Audit Contractor (RAC) to focus solely on Home Health,...more

King & Spalding

Annual RAC Report Shows Significant Drop in Recoveries by CMS in 2014

King & Spalding on

On October 15, 2015, CMS released its annual recovery auditing report to Congress. CMS’s Recovery Auditor (RAC) program identifies and corrects improper payments through a combination of prepayment and post-payment reviews,...more

Akerman LLP - Health Law Rx

Two-Midnight Rule Update

The Centers for Medicare and Medicaid Services (CMS) announced a further delay, through December 31, 2015, of the Recovery Auditors’ (RA) audits of the “Two-Midnight” Rule. Congress previously passed a law delaying...more

K&L Gates LLP

MACRA Brings Modifications to the Recovery Audit Program

K&L Gates LLP on

This is the second K&L Gates Health Care Client Alert discussing the “Medicare Access and CHIP Reauthorization Act of 2015” (MACRA), signed into law by President Barack Obama on April 16, 2015. This alert focuses on...more

Poyner Spruill LLP

Shorts on Long Term Care - February 2015

Poyner Spruill LLP on

In this issue: - Document Retention in a Long Term Care Facility - Medicare RAC Program Improvements Delayed Until 2016 - “Bring Your Own Device” To Work Programs - NLRB Upends Legality of Employer Email...more

Cozen O'Connor

Health Care Reform Implementation Update August 2014

Cozen O'Connor on

The Centers for Medicare and Medicaid Services (CMS) made announcements this week regarding the Open Payments system and the availability of Affordable Care Act (ACA) Consumer Assistance Program grant funds, issued a request...more

Faegre Drinker Biddle & Reath LLP

Who Audits the Auditors?

Since the advent of Medicare in 1965, hospitals have bemoaned the cost and burden of Medicare audits. The complaints increased when CMS hired private contractors for the audits. They became deafening in 2009 with the advent...more

Williams Mullen

CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans

Williams Mullen on

On April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision with significant...more

King & Spalding

Recently Released Data Show Current Status and Future of Medicare Integrity Efforts

King & Spalding on

Last week, CMS and the Government Accountability Office (GAO) published two reports concerning Medicare contractor developments. In the Medicare Fee for Service National Recovery Audit Program Quarterly Newsletter, CMS...more

Mintz - Health Care Viewpoints

For New Recovery Audit Contracting Cycle, CMS “RAC”s up Changes

Last month, the Centers for Medicare & Medicaid Services (CMS) announced important changes to the Recovery Audit Program. The agency had already begun the procurement process to find new Recovery Audit Contractors (RACs) in...more

Baker Donelson

CMS Issues FAQs for Inpatient "2 Midnight" Rule

Baker Donelson on

CMS issued its first set of FAQs on the new 2 midnight inpatient admission standards [PDF] on September 26. In those FAQs, CMS stated: - Medicare Administrative Contractors (MACs) and Recovery Auditors are not to...more

The Volkov Law Group

Hospitals And Fraud Enforcement

The Volkov Law Group on

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

King & Spalding

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

King & Spalding on

On February 5, 2013, CMS sent Congress a report summarizing developments related to its Medicare recovery audit program for fiscal year (FY) 2011. According to the report (titled Recovery Auditing in the Medicare and...more

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