E/M Coding & Audit Tools
OIG Report on Recovery Audit Contractors’ Fraud Referrals Download the complete report HERE Excerpts from EXECUTIVE SUMMARY OBJECTIVES To determine the extent to which: recovery audit contractors (RAC) referred cases of potential fraud to the Centers for Medicare & Medicaid Services (CMS) during the demonstration project, and CMS provided training to RACs regarding fraud identification […]
RACs identify fraud cases and improper payments The Centers for Medicare & Medicaid Services (CMS) conducted a demonstration project from 2005 to 2008 to detect and correct past improper payments in the Medicare fee-for-service program, and to provide information to CMS and the Medicare claims processing contractors that could help protect Medicare trust funds by […]
Realized Nearly $4 Billion in Settlements, Fines, Penalties & Restitution In fiscal year (FY) 2009, OIG’s enforcement efforts resulted in over 670 criminal actions, of which 515 involved heath care fraud; over 362 civil actions (355 involved health care fraud); and realized nearly $4 billion in settlements and court-ordered fines, penalties, and restitution, approximately 75 […]
Enabling More Programs Like Recovery Audit Contractors The following documents from the White House website direct all federal departments and agencies to “expand and intensify their use of payment recapture audits under their current authority.” President Obama Announces New Effort to Crack Down on Waste and Fraud Presidential Memorandum Regarding Finding and Recapturing Improper […]
Restructure Will Happen Before CMS Gets a New Chief The Centers for Medicare & Medicaid Services (CMS) is being restructured, despite lacking a Senate-confirmed administrator since the last one stepped down October 2006. The new structure adds a new pricipal deputy administrator, reporting directly to Acting CMS Administrator Charlene Frizzera. Firzzera announced the changes Feb. […]
Expect More Programs Like Recovery Audit Contractors President Obama signed a presidential memorandum directing all federal departments and agencies to “expand and intensify their use of payment recapture audits under their current authority,” on March 10. No additional legislation is needed, therefore, for the agencies to enact programs similar to CMS’s Recovery Audit Contractors program. […]
Scheduled 21% Pay Cut for Physician Services to Medicare Beneficiaries Delayed 30 Days On March 2, the US Senate once again delayed enacting a scheduled 21% payment cut for physicians who provider Medicare services. The lopsided vote, 78-19, concerns the Temporary Extension Act of 2010 (H.R. 4691), and includes extensions to unemployment benefits, and […]
AMA Letter to Senate: Repeal Medicare Payment Formula This Month The AMA issued a statement calling on the Senate to “use this time wisely to repeal a broken payment formula.” The House has passed legislation that would have repealed the funding formula, and now the Senate needs to act, according to the statement. The […]