Recovery Audit Contractor (RAC) Issues Pertaining to Hospice

Hospices should be aware of the following Recovery Audit Contractor (RAC) issues pertaining to hospice patients. Physician Services During Hospice Period – 8/16/2018 DME While in Hospice – 9/20/2018 Outpatient Hospice-Related Services – 11/28/2018 Each of these issues looks at non-hospice providers and whether the reason for the service is related to the hospice diagnosis.…

CMS Proposes to Begin RCD on December 10, 2018

The Centers for Medicare & Medicaid Services has issued a second Paperwork Reduction Act (PRA) notice for public comment for the Home Health Pre-Claim Review Demonstration (A.K.A. Review Choice Demonstration). This notice is for a 30-day public comment period CMS proposes to initially implement the demonstration in Illinois, Ohio, North Carolina, Florida, and Texas with…

Report: Improvements Needed to Prevent Medicaid Managed Care Payment Risks

The Centers for Medicare & Medicaid (CMS) should require states to report and document the amount of overpayments by managed care organizations to providers in order to eliminate improper payments, according to a new study from the Government Accountability Office (GAO). Under this Medicaid model, states pay a set periodic amount to MCOs for each beneficiary and…

Recovery Audit Contractor to Conduct Home Health Reviews

The Recovery Audit Contractor (RAC) Performant Recovery, Inc. will be conducting a complex home health review for documentation and medical necessity, according to an announcement from the Centers for Medicare & Medicaid Services (CMS). The announcement was posted January 10, 2018. The review will be for all Region 5 “HHA MACs except for the following…