Posts Tagged RAC audits


RAC Alert: How to Bill Medicare for Hospice Patients When You Are Not the Hospice Provider

Hospice Care

What is Hospice?

Hospice care focuses on improving the quality of life for persons and their families faced with a life-limiting illness. The primary goals of hospice care are to provide comfort, relieve physical, emotional, and spiritual suffering, and promote the dignity of terminally ill persons. Hospice care neither prolongs nor hastens the dying process. As such, it is palliative not curative. Hospice care is a philosophy or approach to care rather than a place. Care may be provided in a person’s home, nursing home, hospital, or independent facility devoted to end-of-life care.

How is Medicare Hospice Care Paid?


Posted in: Collections, Billing & Coding, Compliance, Day-to-Day Operations, Medicare & Reimbursement

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Faced a RAC Recovery Audit? Take Frank Cohen’s Survey!

If you have, please consider taking a few minutes to fill out the post-Audit survey being compiled and made available free by the Frank Cohen Group. This is the last week the survey is being offered, so hurry!

Centers for Medicare and Medicaid Services Logo

“Just a reminder that the RAC audits and appeals survey will close on Monday the 17th – so if you haven’t responded, please do so as soon as possible. The results of this survey will be passed along to congressional representatives to aid in their case for creating an accountability provision for the RAC auditors. It has become quite obvious that RACs have become far too aggressive and zealous with regard to their audit tactics and findings, invalidating their original purpose. The concern is that, by acting in an abusive manner, RACs are actually adding to the cost of healthcare, not reducing it.

The survey is only six questions and takes less than three minutes to complete; so I urge anyone who has been subject to a RAC audit in the past year to please respond. You can access the survey at by clicking on the Surveys tab.

Thanks again for your help. I will be publishing the results shortly after the survey has closed.”

Taking the survey is a great, quick way to have your voice as a medical practice manager heard by policymakers and the voting public at large. Take advantage of it!

Posted in: Collections, Billing & Coding, Compliance, Finance, General, Medicare & Reimbursement

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RAC Prepayment Reviews – the Game is Changing: CMS Provider Call on August 9th

Medicare Fee-For-Service Recovery Auditor Prepayment Review Demonstration

Thursday, August 9, 2012

2:00PM – 4:00PM ET

Conference Call Only

The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss the recently approved Recovery Auditor Prepayment Review Demonstration that will begin August 27, 2012.

This Special ODF is designed specifically for Medicare Fee-For-Service providers who may be subject to Recovery Auditor review in the 11 approved demonstration states: FL, CA, MI, TX, NY, LA, IL, PA, OH, NC, and MO. Recovery Auditors will review claims before they are paid to ensure that the provider complied with all Medicare payment rules. These reviews will focus on certain types of claims that historically result in high rates of improper payments. Initially, Recovery Auditors will review short stay inpatient hospital claims. This demonstration will also help lower the error rate by preventing improper payments, rather than the traditional “pay and chase” methods of looking for improper payments after they have been made.

During this ODF, CMS will provide an overview of the Recovery Auditor Prepayment Review Demonstration, including:


Posted in: Collections, Billing & Coding, Compliance, Medicare & Reimbursement

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The Cohen Report: Analysis and “Quickinar” of the NCCI 17.1 Changes Effective April 1, 2011

There are 11,831 new edit pairs, which pushes the total for effective edits to 709,527.  There were 346 terminations for a net gain of 11,485.  In this release, we find that there are around 350 edit pairs that have termination and/or effective dates retroactive to an earlier period with some going as far back as October, 2001.  In fact, all but 10 of the terminated edit pairs are retroactive, adding to the complexity of billing and possible targets for RAC auditors.

If you would like to get a copy of his summary report along with a couple of worksheets that detail these changes, go to and click on the Download tab.  There is no charge for the analysis or the worksheets.

Free Quikinar on NCCI

Frank will also be conducting a brief (free) Quickinar„¢ to go over the NCCI policies and changes for this release on March 24, 2011 from 11:00 to 11:30.  To register, go to his website at and click on the Quickinar tab.

If you have any questions, please feel free to contact Frank Cohen.

The Frank Cohen Group, LLC

855.THE.GROUP (855.843.4768)

Direct:  727.322.4232

Posted in: Medicare & Reimbursement, The Cohen Report (NCCI & RVUs)

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