GreisGuide to LTACHs » recovery audit contractor

California Hospital Files First Lawsuit Challenging a Recovery Audit Contractor Reopening

Jason Greis — Tue, 12 May 2009 00:33:48 +0000

A California hospital recently challenged the decision of a Medicare recovery audit contractor (RAC), alleging that the RAC unlawfully reopened claims submitted by the hospital. Palomar Medical Center v. Johnson, S.D. Cal., No. 3:09-cv-00605-BEN-NLS (S.D. Cal. complaint filed 3/24/09). The case is the first since the inception of the Medicare RAC program to challenge the ability of RACs to reopen Medicare claims more than one year after payment, and its outcome will significantly affect the ability of hospitals to generally treat Medicare payments as final a year after receipt. Read More...

RAC Provider Outreach Scheduled for California Hospitals

Jason Greis — Thu, 23 Apr 2009 00:40:52 +0000

The Centers for Medicare & Medicaid Services (CMS) will be offering several informational sessions on the Recovery Audit Contractor (RAC) Program. Presenting with CMS will be the RAC for California, HealthDataInsights, Inc. These sessions will take place at the CMS San Francisco Regional Office located at 90 7^th Street in San Francisco, California. Read More...

GreisGuide to LTACHs Newsletter (April 2009)

Jason Greis — Fri, 17 Apr 2009 01:49:36 +0000

This issue of the GreisGuide to LTACHs Newsletter contains articles and information on: Read More...

Medicare Recovery Audit Contractor (RAC) Update – Spring 2009

Jason Greis — Tue, 07 Apr 2009 03:51:40 +0000

Members of the McGuireWoods RAC Response Team recently authored a primer on RAC appeals. The article provides a short overview of the RAC demonstration program results related to appeals and provides a useful overview of the RAC appeals process. Once providers receive a demand letter claiming an overpayment, the timeframes for appealing are short and providers need to be prepared to proceed through the appeals process if a solid basis for such appeal exists. The RAC appeals process mirrors the five-level Medicare claims appeals process through which fee-for-service providers appeal payment decisions and the article walks providers through the requirements of each level.

LTCHs, RACs and Medical Necessity Update

Jason Greis — Sat, 28 Mar 2009 01:06:53 +0000

By Carol Burkhart, RN, MS, CNP, CPHRM, William Hammock, RN, BSN, CMC, ACM, and Stacey Donegan, CPC Read More...

Recovery Audit Contractor (RAC) Frequently Asked Questions

Jason Greis — Sun, 15 Mar 2009 03:20:26 +0000

I have attached a list of Frequently Asked Questions from the March 3, 2009 McGuireWoods and Marsh webinar presentation entitled “RACs are Here: Are You Prepared?” Many LTACHs listened in and asked questions regarding how to prepare for a RAC audit, how and when to respond to a RAC request for medical records or a demand letter, and how and when to appeal a RAC overpayment determination. Please also click here for a copy of the PowerPoint slides from the presentation. Read More...

Medicare Recovery Audit Contractors (RACs): What Providers Need to Know and How to Prepare

Jason Greis — Thu, 05 Mar 2009 04:59:21 +0000

RAC audits are on their way in 2009 and all providers should strive to be prepared. In a depressed economy in which most providers are experiencing decreased or stagnating reimbursement, an additional hit to the bottom line from a RAC audit is especially unwelcome. There is, however, much providers can do to proactively prepare in advance of receiving a RAC demand letter or medical record request.

“RACs Are Here: Are You Prepared?” Webinar Slideshow

Jason Greis — Wed, 04 Mar 2009 04:58:45 +0000

Please click here for a copy of the PowerPoint slides from the March 3, 2009 McGuireWoods and Marsh webinar presentation entitled “RACs are Here: Are You Prepared?” This webinar addressed questions about what recovery audit contractors (or RACs) are, how to prepare for a RAC audit, how and when to respond to a RAC request for medical records or a demand letter, how and when to appeal a RAC overpayment determination, and a discussion of the other inherent risks embedded in the RAC audit process. Please feel free to contact me if you have any questions about the presentation or related to the RAC process or audits. Read More...

RAC Program Proceeds; Bid Protest Withdrawn

Jason Greis — Wed, 18 Feb 2009 00:26:56 +0000

On February 14, 2009 my colleague, Elissa Moore, posted the following informative update on the North Carolin Healthcare Report weblog, of which she is a co-Author. The posting describes the resumed rollout of CMS’s recovery audit contractor (RAC) program and further details of the RAC program. Elissa, Brent Rawlings, and I (together with members of Marsh Risk Consulting’s Global Clinical HealthCare Consulting Team) will be discussing the impact of RAC audits on post-acute and acute care providers during a complimentary 1-hour webinar on March 3, 2009. Please click here for additional information and to register for the webinar. Read More...

GreisGuide to LTACHs Newsleter (February 2009)

Jason Greis — Mon, 02 Feb 2009 22:06:17 +0000

This issue of the GreisGuide to LTACHs Newsletter contains articles and information on:

Launch of the Community Forum page of the weblog;
Information on an upcoming webinar addressing recovery audit contractor issues and information on McGuireWoods annual healthcare private equity conference;
The House SCHIP bill’s inclusion of a provision banning physician ownership and investment in hospitals (including LTACHs);
The Disclosure of Financial Relationships Report;
Strategic considerations when entering into physician call-coverage agreements;
An interview with Jerry Amato, CEO of Specialty Hospital of Washington-Hadley; and
Facility development updates.

Please click here for a .PDF copy of this Newsletter. Read More...