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OIG issues Work Plan
On October 1, the OIG issued its Work Plan for FY 2010.
RACs have begun auditing at this point, and providers in some states may have received their first denial letters this week. But many providers seem to still be waiting, holding their breath, and worrying whether the mail carrier might deliver their first RAC demand letter(s) that day.
However tempting it may be to simply wait, providers can still use this time effectively. Consider the following tips from several RAC experts: Read More→
By Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc.
On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local Coverage Determination (LCD) exceptions. When specific authorized contractors conduct a complex medical review, they have the authority (in rare and unusual circumstances) to apply an exception to the “reasonable and necessary” requirements described in an LCD to approve or deny a claim. However, they cannot make exceptions to National Coverage Determinations (NCDs). In addition, and unless otherwise directed by CMS, RACs can only use the exceptions process to not deny a claim. This is a good time to review the difference between a national and a local coverage determination policy.
Click over to the MedicareMentor Blog to read more.
DCS Healthcare has released its first CMS-approved issues for audits in Region A.
The three issues, including one new issue not yet approved in other RAC regions, are applicable to durable medical equipment (DME) suppliers in Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
According to the DCS Web site, the issues include the following: Read More→
At this point, thanks to a three-year demonstration project and a plethora of available information available for providers, the healthcare industry generally knows what providers are up against in terms of RAC audits. Not that they’ll be easy to handle, but there’s a lot of information out there for providers to help them manage the process.
Unfortunately, comparatively few providers seem to know what to expect with Medicaid Integrity Program audits—which have already begun in many areas across the nation—and in many cases, information that could help them is lacking.
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