News & Analysis as of

Recovery Audit Contractors (RACs) Centers for Medicare & Medicaid Services (CMS)

BakerHostetler

Healthcare Industry Team 2023 Year in Review

BakerHostetler on

As we approach the conclusion of another transformative year, we are excited to present our comprehensive year-end review, shedding light on the trends shaping the healthcare market in 2023. Our team’s keen insights and...more

Maynard Nexsen

Billing Medicare or Medicaid? Understanding Your Audit Risk

Maynard Nexsen on

If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit...more

Oberheiden P.C.

5 Defense Strategies for MAC/RAC Audits

Oberheiden P.C. on

Medicare pays billions of dollars in fraudulently billed claims each year despite the various tools the Medicare system has at its disposal. Because of this problem, the Centers for Medicare and Medicaid Services (“CMS”)...more

King & Spalding

CMS Releases Calendar Year 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule

King & Spalding on

On December 2, 2020, CMS issued the calendar year (CY) 2021 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. Through these policy changes, CMS seeks to...more

Polsinelli

CMS Delays Price Transparency, Doubles Down on Site-Neutral and 340B Payment Policies in CY 2020 OPPS Final Rule

Polsinelli on

Late last week, the Centers for Medicare & Medicaid Services (“CMS”) released the CY 2020 Hospital Outpatient Prospective Payment System (“OPPS”) final rule [CMS-1717-FC]. While many hospitals had hoped for relief from recent...more

Morgan Lewis

CMS Administrator Touts Changes to RAC Program

Morgan Lewis on

In CMS’s continuing effort to take “a strategic approach to protecting taxpayer dollars and reducing regulation to put patients over paperwork,” Administrator Seema Verma recently highlighted changes to the Recovery Audit...more

Roetzel & Andress

CMS Ends Moratorium On New Home Health Agencies In Illinois And Implements Review Choice Demonstration For Home Health Services

Roetzel & Andress on

The Social Security Act grants the Centers for Medicare and Medicaid Services (“CMS”) the authority to impose a moratorium on enrollment of home health agencies (“HHAs”) in the Medicare and Medicaid programs if CMS...more

K&L Gates LLP

Upcoming Changes Regarding the Use of Statistical Sampling for Overpayment Estimation

K&L Gates LLP on

In a September 28, 2018 Change Request to Medicare’s Program Integrity Manual (“PIM”), the Centers for Medicare & Medicaid Services (“CMS”) updated its instructions to Medicare contractors regarding the use of statistical...more

Dorsey & Whitney LLP

CMS To Expand Use of TPE Audits Nationwide by End of 2017

Dorsey & Whitney LLP on

Perhaps lost amid the healthcare news coverage of competing proposals regarding “Medicare for All” and the repeal of Obamacare, the Centers for Medicare & Medicaid Services (“CMS”) last month announced the expansion of its...more

Arnall Golden Gregory LLP

CMS Issues Guidance to Change Medical Reviewer Requirements for Complex Medical Reviews

Effective September 12, 2017, the Centers for Medicare & Medicaid Services (CMS) will implement changes to ensure that complex reviews for coverage determinations are performed by Registered Nurses (RNs), therapists, or...more

Mintz - Health Care Viewpoints

Hospitals and Others Respond to “Red Tape Relief Project” Requests

Last week, a number of health care industry associations sent letters to Congress detailing ways in which the government could relieve them of the burdens associated with “red tape.” The letters are in response to the first...more

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

K&L Gates LLP

Health Care Institutions

K&L Gates LLP on

Originally published in Haig, Business and Commercial Litigation in Federal Courts, Fourth Edition §§ 87:1 et seq. © 2016 American Bar Association. This chapter discusses federal court litigation relating to health care...more

King & Spalding

Also In The News - Health Headlines - November 2016

King & Spalding on

CMS Names Latest Round of RAC Contracts – On October 31, 2016, CMS announced it awarded contracts for its Medicare Fee-for-Service Recovery Audit Contractors (RAC) to Performant Recovery, Inc. (Region 1), Cotiviti, LLC...more

Poyner Spruill LLP

CMS Lifts Temporary Suspension of Short Stay Reviews

Poyner Spruill LLP on

Effective September 12, 2016, Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) resumed their hospital initial patient status reviews. The purpose of these reviews is to determine the...more

Latham & Watkins LLP

A Favorable, New Climate for Challenging Medicare Appeals

Latham & Watkins LLP on

Over the past decade, health care providers seeking to challenge Medicare claim denials have faced increasing delays in reaching what many consider the most important step in the Medicare appeals process - a hearing before an...more

King & Spalding

GAO Report Finds Medicare Claim Review Programs Could Be Improved with Additional Prepayment Reviews and Better Data

King & Spalding on

On May 13, 2016, the U.S. Government Accountability Office (“GAO”) released a report on the review activities of the different Medicare claim review contractors that CMS uses to help reduce improper payments and protect the...more

Faegre Drinker Biddle & Reath LLP

And You Thought RAC Audits Couldn’t Get Any Worse

If there’s one thing that unites the hospital industry—even the fiercest competitors—it’s hatred of audits by recovery audit contractors, or RACs. Why? For one thing, because RACs operate on a contingency fee basis. They...more

King & Spalding

CMS Announces Risk-Based Adjusted Additional Documentation Request Limits for Institutional Providers

King & Spalding on

On May 3, 2016, CMS announced the availability of a revised method to calculate additional documentation request (ADR) limits for Institutional Providers in the Recovery Audit Contractor (RAC) Program. Under the new method,...more

King & Spalding

President Obama’s Proposed Fiscal Year 2017 Budget Would Establish Competitive Bidding in Medicare Advantage Plans, Reduce...

King & Spalding on

On February 9, 2016 the Obama administration released its proposed fiscal year (FY) 2017 budget. The budget, which would top $4 trillion, allocates nearly $1 trillion to CMS. This is an increase of $26 billion from the FY...more

Mintz - ML Strategies

Health Care Update - February 2016 #4

Mintz - ML Strategies on

What to Expect from Congress this Work Period - The next Hill work period basically runs from February 22nd to March 23rd. As Congress returns, here’s a brief look at the pending health care issues on the radar for this...more

McDermott Will & Emery

Preview of Medicare Advantage and Part D Advance Notice and Call Letter: CMS Likely to Address Risk Adjustment, Provider Network,...

McDermott Will & Emery on

The federal government will soon kick off the all-important annual sub-regulatory cycle for the Medicare Advantage (MA) and Part D programs, issuing proposed policy changes and payment rates for calendar year (CY) 2017. The...more

Pillsbury Winthrop Shaw Pittman LLP

CMS Proposes Expansion of RAC Program to Medicare Part C – All Medicare Advantage Contracts to Become Target of RADV Audits

On December 22, 2015, the Centers for Medicare & Medicaid Services (CMS) released a request for information (RFI) and a proposed statement of work (SOW) seeking industry feedback on the expansion of the recovery audit...more

Foley & Lardner LLP

Medicare Proposes to Increase RAC Use

Foley & Lardner LLP on

By now, providers are very familiar with Medicare recovery audit contractors, or RACs – the private companies who have authority to review medical records at a moment’s notice. For every dollar they opine has been improperly...more

King & Spalding

CMS Preparing to Launch RACs for Medicare Advantage

King & Spalding on

On December 22, 2015, CMS issued a Request for Information (RFI) detailing plans to expand its Recovery Audit Contractor (RAC) program to cover Medicare Advantage organizations. ...more

86 Results
 / 
View per page
Page: of 4

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide