Since the inception of the permanent recovery audit contractor (RAC) program, government auditors have identified claims errors in excess of $350—$313.2 million of which were identified as overpayments and recouped by the government. ...Read More »
Hospital acquired conditions (HAC): The phrase seems simple enough to understand. These are conditions one acquires while in the hospital, right? Like most phrases included in the healthcare vernacular, however, discussion of HAC contains various levels of detail that can be difficult to...Read More »
There has been much discussion based on what Recovery Audit Contractors (RAC) and other state and federal regulatory bodies are doing or what their next move will be (though does anybody really know?!?).
We’ve all heard the stories of denials of well...Read More »
A recent special edition MedLearn Matters article SE1028 outlines four risk areas targeted by the recovery audit contractors (RACs). Of particular concern, according to William E. Haik, MD, FCCP, a pulmonologist and director of DRG Review, Inc., in Fort...Read More »
The RACs have ramped up medical necessity reviews. Determining the medical necessity of an inpatient admission can be a complex process so we have to look at several different places for CMS guidance.
According to the Medicare Benefit Policy Manual, Chapter 1, § 10, an “inpatient...Read More »
CMS plans limited changes to CCs in fiscal year (FY) 2012, but proposes new MS-DRGs for excisional debridement as well as an additional hospital-acquired condition (HAC). These and other changes are part of the inpatient prospective payment system (IPPS) proposed rule posted April 19. The...Read More »
Starting October 2012, Medicare will begin paying hospitals for quality measures, according to a CMS fact sheet released April 29. The new Hospital Value-Based Purchasing (VBP) program adopts performance measures under two “domains”:
