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In a series of communications to HHS and the Centers for Medicare and Medicaid Services (CMS) in October, U.S. Sen. Chuck Grassley, the ranking member of the Senate Finance Committee, which holds jurisdiction over Medicare and Medicaid, has been voicing a number of concerns regarding conflicts of interest on the part of CMS contractors.
"Can You Hear Me (Us) Now??!" I wish I had coined that phrase years ago! So many of us responsible for education, training and consulting within the healthcare industry feel that we sometimes speak to deaf ears regarding some basic components related to payment and reimbursement, documentation, medical coding, claim creation, billing and compliance.
The RACs will now be responsible for referring to CMS any cases of potential fraudulent activity identified during the course of their own improper payment investigations.
We all suspected it, but now it's official: RACs will be providing information to CMS for follow-up on cases of possible fraud.
The RAC program is just one of the CMS programs designed to ramp up "benefit integrity" efforts and to otherwise preserve or recoup cash for the trust fund. Providers must be aware of all the alphabet soup measures.
The RACs certainly have our attention. The MACs (i.e., Fiscal Intermediaries and Carriers and Medicare Administrative Contractors), however, deserve as much if not more of our attention.
Medicare patients increasingly fall into a "medical necessity" gray area between inpatient admission and observation/outpatient designation.
The Centers for Medicare and Medicaid Services has announced "aggressive new steps" to find and prevent waste, fraud and abuse in Medicare.In a separate announcement, CMS also has...
