February, 2011 - Make Your Revenue Smarter

State Medicaid RACs

On , in Documents, by AQ-IQ LLC

State Medicaid RACs At-A-Glance Section 6411 of the Affordable Care Act of 2010 required States and territories to establish Medicaid Recovery Audit Contractor (RAC) programs. Medicaid RACs are tasked with identifying and recovering Medicaid overpayments and identifying underpayments. As an initial step for establishing their RAC programs, jurisdictions are expected to submit a Medicaid State […]

Expansion of IPPS Transfer Policy to Include Critical Access Hospitals (CAHs) and Non-Participating Hospitals

On , in Documents, by AQ-IQ LLC

MLN Matters Number: MM7141 Related Change Request (CR) #: 7141 Related CR Release Date: November 12, 2010 Effective Date: October 1, 2010 Related CR Transmittal #: R807OTN Implementation Date: April 4, 2011 [The following is copied directly from this MLN Matters posting by CMS.] Expansion of Inpatient Prospective Payment System (IPPS) Transfer Policy to Include […]

HHS imposes a $4.3 million civil money penalty for violations of the HIPAA Privacy Rule

On , in Industry News, by AQ-IQ LLC

Action marks first civil money penalty issued by HHS for HIPAA Privacy Rule violations The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, Md., (Cignet) violated the Privacy Rule of the Health Insurance Portability and […]

RACs Post 60 New Issues, 41 for Medical Necessity

On , in Industry News, by AQ-IQ LLC

Region C List Riddled with Errors Two of the CMS Recovery Audit Contractors (RAC) posted newly approved issues last week to their public websites, as required by CMS before widespread review of those issues can begin. Connolly Healthcare, the RAC for CMS Region C posted 36 new issues on their Approved Issues webpage, on Wednesday, […]

RACs Post 60 New Issues, 41 for Medical Necessity

Region C List Riddled with Errors Two of the CMS Recovery Audit Contractors (RAC) posted newly approved issues last week to their public websites, as required by CMS before widespread review of those issues can begin. Connolly Healthcare, the RAC for CMS Region C posted 36 new issues on their Approved Issues webpage, on Wednesday, […]

Auto Denial of Claims Submitted With a GZ Modifier

On , in Documents, by AQ-IQ LLC

This document is from: MLN Matters Article #:MM7228 Posted: February 4, 2011                                Related CR#: 7228 Effective Date: July 1, 2011 Auto Denial of Claims Submitted With a GZ Modifier The GZ modifier indicates that an Advance Beneficiary Notice (ABN) was not issued to the beneficiary and signifies that the provider expects denial due to a […]