RACs

News & Analysis as of

MedPAC Report to Congress on Medicare and the Health Care Delivery System

The Medicare Payment Advisory Commission (MedPAC) has released its June 2015 Report to the Congress on Medicare and the Health Care Delivery System. The report includes a series of recommendations on Medicare hospital...more

MedPAC Releases June 2015 Report to the Congress

The Medicare Payment Advisory Commission (MedPAC) released its “Report to the Congress: Medicare and the Health Care Delivery System” on June 15, 2015. As previously reported, the report makes recommendations for policy...more

Senate Committee Passes Bill Addressing Medicare Appeals Inefficiencies

On June 3, 2015, the Senate Finance Committee passed an original bill that aims to streamline and improve the Medicare Audit and Appeals Process. The Medicare appeals process has recently faced scrutiny from industry leaders...more

MACRA: three compliance implications for Medicare providers

Much has been written about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its repeal of the Sustainable Growth Rate formula for physician compensation and the potential gainsharing safe harbor. But the...more

RAC Reform Legislation Reintroduced in House

On April 30, 2015, Representatives Sam Graves (R-MO) and Adam Schiff (D-CA) reintroduced H.R. 2156, the Medicare Audit Improvement Act of 2015. H.R. 2156 contains a number of significant new provisions from legislation of...more

MedPAC Approves Recommendations Regarding RAC Program and Short Stay Policies

At its public meeting last week in Washington, D.C., the Medicare Payment Advisory Commission (MedPAC), a congressional advisory panel on Medicare payment and policy issues, considered a number of final policy recommendations...more

New and Improved RACs

During the CMS Hospital/Quality Initiative Open Door Forum call on February 24, 2015, CMS issued a 4-page document summarizing the improvements it has implemented to the RAC program. CMS introduced 20 changes to address...more

Health Law Pulse - January 2015

In This Issue: - Connecticut Supreme Court Rules State Does Not Recognize Mature Minor Doctrine - OIG Issues Advisory Opinion Permitting Copayment Assistance - CMS Announces Recovery Audit Program...more

New Limitations on RAC Program

In March 2014, CMS temporarily suspended the Recovery Audit Contractor (RAC) program until it secured new contracts. The contracts for the program expired in June 2014, and in August, CMS said that it would restart the...more

CMS Announces Updated List of RAC Program Improvements For New Contracts, Beginning With the Newly Awarded DME, Home Health, and...

On December 30, 2014, CMS announced that it has awarded a new Recovery Audit Contractor (RAC) contract to Connolly LLC to identify improper Medicare payments nationwide made to suppliers of durable medical equipment,...more

CMS Announces 20 Repairs to RAC Program

Ever face the choice between trading in your old car or paying for multiple repairs? CMS faced that kind of choice with its Recovery Audit Contractor (RAC) program. Under the RAC program, contract auditors audit hospitals...more

AHA Proposes Putting RACs on the Rack

The American Hospital Association formally proposed last week that Recovery Audit Contractors (RACs) be fined when their denials are overturned on appeal....more

Proposed Federal Legislation Will Provide Relief to Hospitals and Medicare Patients in Need of Post-Acute Care

The Center for Medicare and Medicaid (CMS) announced that the new RAC contracts in North Carolina should be ready by the end of the year. This means that, next year, RAC audits on hospitals and other providers will...more

MedPAC Considering Changes to Hospital Short-Stay Policies and Associated RAC Audits

Last week at its monthly meeting, the Medicare Payment Advisory Commission (MedPAC) discussed current issues with hospital short-stay policies. Specifically, MedPAC discussed the possibility of reducing the incentive to admit...more

Critical Access Hospital Soothsayers and the 96-Hour Physician Certification Requirement

This year critical access hospitals (CAH) have struggled to implement procedures to comply with both the "two-midnight" rule and the 96-hour physician certification requirement. The combination of both puts physicians in a...more

CMS Issues 2013 RAC Report to Congress

On September 29, 2014, CMS released the Fiscal Year (FY) 2013 Recovery Audit Contractor (RAC) report. According to the report, RACs collected $3.65 billion in Medicare overpayments during FY 2013. In addition, the report...more

CMS Makes Limited Time Offer to Settle RAC Claims Pending Appeal

The Centers for Medicare and Medicaid Services (CMS) made an offer to settle currently pending RAC appeals for partial payment of 68 percent of the net claim amount if a hospital agrees to withdraw all of its RAC appeals. The...more

CMS Offers To Settle All Acute Care Inpatient Claim RAC Appeals

CMS is offering to pay hospitals 68 percent of the allowable amount for all claims that are currently on appeal. Specifically, CMS is offering to settle "inpatient status" claims at 68 percent of the "net paid amount" within...more

North Carolina’s Medicaid RAC Program - Don't Let Your Guard Down

With Section 6411(a) of the Patient Protection and Affordable Care Act (ACA) and the Final Rules found at 42 CFR Part 455, the Recovery Audit Contractor (RAC) program has been expanded to the North Carolina Medicaid program,...more

CMS Offers Deal to Hospitals to Drop RAC Appeals

On August 29, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a deal to hospitals willing to drop pending inpatient-status claims appeals. These appeals have grown exponentially in recent years due to the...more

Federal Court Rejects Challenge to new CMS Recovery Auditor Contracts

On August 22, 2014, the U.S. Court of Federal Claims denied a challenge by incumbent Recovery Audit Contractor (RAC) CGI Federal, Inc. (CGI) to CMS’s plan to award new RAC contracts. Among other things, the Court found that...more

Special (Limited) CMS Offer to Settle Claims on Appeal

With little fanfare just before the Labor Day weekend, CMS announced a program in which it would enter into administrative agreements with eligible providers in exchange for the providers’ withdrawal of pending appeals...more

CMS Makes Global Offer to Settle All Acute Care Inpatient Claims on Appeal

On August 29, 2014, CMS issued settlement terms to acute care hospitals with pending appeals of denials for inpatient claims. CMS is offering to settle all qualifying claims at 68 percent of the “net paid amount” of such...more

Limited Restart of RAC Program

On August 4, 2014, CMS announced that, due to the continued delay in awarding new Recovery Audit Contractor (RAC) contracts, CMS will modify its current RAC contracts to allow for a limited number of reviews of Medicare...more

Senate Special Committee on Aging Addresses Medicare Audits

On July 9, 2014, the United States Senate Special Committee on Aging released a report titled “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations.” Among other recommendations, the report...more

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