CMS published a new version of the Recovery Audit Contractor (RAC) Statement of Work, this morning, in a document dated September 1, 2011. Changes are few, but most significantly, the document now includes the Semi-Automated Review, as an integrated, fully approved method of audit and review. Other changes include paragraphs including the Discussion Period and the posting of new issues to the RAC websites. Continue reading
Providers familiar with automated claims reviews and complex claims reviews by the recovery audit contractors (RAC) now face another method of overpayment identification: “Semi-automated” claims review.
Written by Leigh Page | April 04, 2011
With Medicare recovery audit contractors racking up more claims denials, hospitals are forced to put more time and energy into improving their claims-processing track record.
After a relatively easy 2010, “hospitals will be stretched for resources in 2011,” says Dennis Jones, director compliance services for CBIZ KA Consulting Services, based in East Windsor, N.J. “It’s going to be really tough.”
Genie Trafford is the Medicare assessment and care plan coordinator at Laurel Park Skilled Nursing and Rehab Facility at Henry Medical Center, in McDonough, Georgia.
Medicare assessment and care plan coordinator, Laurel Park Skilled Nursing and Rehab Facility, Henry Medical Center in McDonough.
What I do:
“I keep up with the documentation required by CMS [Centers for Medicare/Medicaid Services] for reimbursement. I work with patients needing skilled services — covered by their Medicare or private insurances in conjunction with nursing — and therapy services to help them regain functional abilities that will allow them to return to the community.”
Some hospitals put a RAC coordinator in charge of all RAC duties. However, “this work is too much for one person,” Ms. Lamkin says. One person won’t be able to bring together all the separate silos in the hospital that do not talk to each other. …
Click here to view the original post at Becker’s Hospital Review