Recovery Audit Program

CMS Resumes RAC Audits, Other Medical Review Activities

August 5, 2020 - CMS recently resumed medical review activities, including pre- and post-payment reviews conducted by Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs), which were paused earlier this year due to the COVID-19 public health emergency. According to the American Hospital Association (AHA), CMS ended the suspension of most...

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HHS Ahead of Schedule for Eliminating Medicare Appeals Backlog

by Jacqueline LaPointe

HHS reduced the Medicare appeals backlog at the administrative law judge level by 25 percent through the third quarter of fiscal year (FY) 2019, according to a recent status report obtained by the...

HHS Reduced Medicare Appeals Backlog by 19% Since Fall 2018

by Jacqueline LaPointe

HHS has made significant progress with reducing the Medicare appeals backlog, decreasing the number of appeals pending at the Office of Medicare Hearings and Appeals (OMHA) by about 19 percent as of...

Recovery Audit Contractor Reform Eases Provider Burden, CMS Says

by Jacqueline LaPointe

The Medicare fee-for-service Recovery Audit Contractor (RAC) program found approximately $89 million in overpayments and recovered $73 million in the fiscal year (FY) 2018, CMS Administrator Seema...

Auditors Recouped $214M in Medicare Improper Payments in 2016

by Jacqueline LaPointe

Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In...

Net Medicare Improper Payment Recoveries Dropped 91% in 2015

by Jacqueline LaPointe

Medicare improper payment recoveries saw a significant drop in 2015, according to a recent CMS report to Congress. The Recovery Audit Contractor (RAC) program returned 91 percent less to Medicare during...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

by Jacqueline LaPointe

In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims...

Hospitals Still Facing Medicare Claims Denial Management Issues

by Jacqueline LaPointe

A recent American Hospital Association (AHA) survey indicated that hospitals are still experiencing challenges with Medicare claims denial management under the Recovery Audit Program. The survey of 676...

Can Changes to Medicare Reimbursement Appeals Reduce Backlog?

by Jacqueline LaPointe

The lengthy Medicare reimbursement appeals process poses significant revenue cycle management problems for many providers, yet new proposed fixes from HHS may not do much to solve the problem, argue...

CMS Paid $1.47B to Settle Medicare Reimbursement Disputes

by Jacqueline LaPointe

CMS paid nearly $1.47 billion to healthcare providers last year to settle Medicare reimbursement disputes, according to data recently released by the federal agency. The settlements were distributed to...

60% of RAC Reviewed Claims Showed No Medicare Overpayments

by Jacqueline LaPointe

Reducing healthcare fraud, waste, and abuse has recently been on the top of the CMS agenda, but some healthcare providers are questioning how effective some CMS initiatives are at identifying potential...

Hospitals Facing More Payment Claims Audits, Costly Denials

by Jacqueline DiChiara

Hospitals are allegedly trying to do the best they can, even when money is slow to come in. Nearly half of all Recovery Audit Contractor claim denials are denied by hospitals, according to a new report...

HHS Urged to Resolve Pending Medicare Appeals in Filed Suit

by Jacqueline DiChiara

Casa Colina Hospital and Centers for Healthcare recently filed suit to require timely Medicare patient care appeals mandated under federal law.  The Medicare program is denying payment for...

AMA Calls for Massive Overhaul of RAC Program

by Ryan Mcaskill

In a letter to CMS administrator Marilyn Tavenner, AMA laid out a plan to realign the Recovery Audit Contractor program. With healthcare evolving, the rules and regulations that govern practices need to...

New York OMIG Saves $2B, Recovers $879M in Medicaid Spending

by Ryan Mcaskill

Last week, New York State’s Office of the Medicaid Inspector General (OMIG) released its 2013 annual report that focuses on spending and fraud prevention. It includes the final totals for Medicaid...

CMS releases FY2013 RAC report to Congress

by Elizabeth Snell

The Center for Medicare & Medicaid Services (CMS) released its Medicare fee-for-service Recovery Audit Program’s report to Congress for fiscal year 2013. The report found that Recovery Audit...

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