Podcasts about recovery audit contractor rac

September 15, 2023 Ray, Mark, and Scott discuss what Targeted Probe and Educate (TPE) and Recovery Audit Contractor (RAC) Audits are and how they are different.Mark Painter and PRS ConsultingSchedule a call with Mark Painter / PRS ConsultingUrology Documentation, Coding, and Billing CertificationFor Urologists and APPs (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Fellowship - Urology (DCB-FS) For Coders, Billers, and Admins (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Specialist Certification (DCB-SC)Documentation, Coding, and Billing Master Certification (DCB-MC)Urology Advanced Coding and Reimbursement Seminar(Click Here for More Information and Registration) Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayNew Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayReserve your spot and save!As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).Use code: 24UACRS733Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com

Once suspended by COVID-19, claim audits are now back on the frontburner – Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), and Medicare Administrative Contractor (MAC) audits, plus Targeted Probe-and-Educate (TPE) audits are the new (or renewed) normal. It's open season on providers, which is why, in large measure, the next live edition of Monitor Mondays will feature reports on how audits now being conducted by governmental and third-party contractors are making America “Audit Nation.”Monitor Mondays will have the latest national audit news updates from well-respected broadcast consultants, including:Monday Rounds: Physician and attorney John H. Kall, substituting for Dr. Ronald Hirsch, will make his Monday Rounds, but also will begin a two-part series exploring the landmine liability faced by utilization management (UM) and compliance professionals. Hall is the founder of Aegis Consulting Services.RAC Report: Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Court Report: Famed whistleblower Mary Inman, partner at the law offices of Constantine Cannon, will report on the $25 million Medicaid fraud settlement in Massachusetts, the largest ever in the Bay State.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.

The recent announcement by the Centers for Medicare & Medicaid Services (CMS) that it will be “ramping up” audits are quickly becoming a reality for providers across the country. Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Unified Program Integrity Contractor (UPIC) auditors are going full steam ahead, using data and analytics to assess overpayments via automated reviews – and new language in UPIC letters paints an ominous picture for providers they deem non-compliant.Reporting the lead story during this edition of Monitor Mondays is Sean M. Weiss of DoctorsManagement, who addresses these issues and the steps necessary to ensure a level playing field.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen also conducts the Monitor Mondays Listeners Survey.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Back on March 30, CMS suspended its claims audits for the COVID-19 Public Health Emergency. Well, CMS surprised everyone in August by announcing it would resume those audits. Audit expert Wayne van Halem, president of The van Halem Group, discusses how CMS will likely phase back in the DME MAC Targeted Probe and Education, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC) audits. He also outlines how providers should prepare, and tackles additional questions.

Time is running out for skilled nursing facilities (SNFs). Come Oct. 1, 2019, time will be a thing of the past for such providers, as there will be a new payment methodology for SNFs: The Patient-Driven Payment Model (PDPM). Under PDPM, reimbursement for Medicare Part A patients in SNFs will be driven by patient condition, rather than by therapy minutes provided. Documentation is crucial to avoid a Recovery Audit Contractor (RAC) audit. Reporting our lead story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel. Other segments to appear during the live broadcast include the following:CMS Report: The Centers for Medicare & Medicaid Services (CMS) is cracking down on bad actors: past and present fraudsters. Author, educator, and consultant Duane Abbey, president of Abbey and Abbey Consultants, Inc., reports on CMS efforts to identify those who are or have been affiliated with illegitimate providers.Surprise Balance Billing: While it once appeared to be a done deal leading into the August recess for members of Congress, legislative action on surprise balance billing has stalled out as stakeholders and lawmakers struggle with the details. An update on this now-contentious issue is presented by Matthew Albright, chief legislative affairs officer for Zelis Healthcare and former CMS official.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has latest news on this trending topic that is attracting significant media attention. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

There was a time when therapy documentation was the focus of Recovery Audit Contractor (RAC) audits. Under the Patient-Driven Payment Model (PDPM), however, reimbursement for Medicare Part A patients being treated in skilled nursing facilities (SNFs) will be driven by patient condition, rather than therapy minutes. And this creates a target-rich opportunity for auditors, because certain documentation can easily lead to higher reimbursement – and the likelihood of audits leading to claim denials. Reporting on this development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Other segments to appear during broadcast include:Court Report: The Reckitt Benckiser Group has agreed to pay $1.4 billion to resolve its potential criminal and civil liability related to a federal investigation of the marketing of the opioid addiction treatment drug Suboxone. Whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on how an addiction specialist filed a False Claims Act (FCA) motion leading to the largest settlement in U.S. history related to the opioid crisis.Monday Focus: Senior healthcare analyst Frank Cohen returns to Monitor Mondays with a unique perspective on artificial intelligence (AI). Cohen reports on how the more accurate term for the ubiquitous AI should be “augmented intelligence,” as it relates to non-clinical areas of healthcare.SDoH Report: Ellen Fink-Samnick, nationally recognized expert on the social determinants of health (SdoH), will have the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

An older physician, practicing family medicine for 46 years, opens his door one day and finds an individual who says he works for the U.S. Department of Justice (DOJ), demanding to see medical records.In short order, the agent leaves the premises with charts, and later, the family physician finds himself facing the prospect of a trial by jury that the DOJ is demanding to quantify civil monetary fines and penalties. What could have possibly triggered this investigation?Reporting this developing story during this edition of Monitor Mondays is Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS). DeConda, who personally talked to the rural West Virginia physician, will report on the latest development in the case of a healthcare professional who plans to tell a jury of his peers that he didn’t swindle Medicare for money at their expense.Other segments to appear during the live broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Monday Focus: John K. Hall, MD continues his reporting on the now-infamous blog post of May 2, by Seema Verma, the Centers for Medicare & Medicaid Services (CMS) administrator. Hall reports that he expects that providers can expect more Recovery Audit Contractor (RAC) audits as a result of her blog. Hall is the founder of the Aegis Firm.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on Split Shared Evaluation and Management EM Services.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) recently announced that 800 hospitals will be penalized this year for yielding poor results in the Hospital-Acquired Condition (HAC) Reduction Program, including 110 hospitals that are being penalized for the fifth year in a row (the HAC Reduction Program has only been in existence for five years). The Code of Federal Regulations does not allow a hospital to appeal the determination of poor results in this program, whereas if you are penalized by a Recovery Audit Contractor (RAC) or a Zone Program Integrity Contractor (ZPIC), you do have the right to appeal. With courts now finding that Medicare reimbursements are a property right, is 42 CFR 412.172 unconstitutional because it disallows an appeals process for a decrease in Medicare payments? Reporting this latest development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Other segments to appear on the broadcast include:Monday Focus: The American Hospital Association (AHA) and the National Quality Forum have released a guide to help hospitals and health systems deliver tele-behavioral health services to improve patient outcomes and enhance access to behavioral healthcare. An estimated 44 million Americans have a behavioral health disorder. Reporting this developing story is Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., a telemedicine company providing psychiatric care to patients throughout the United States in partnership with hospitals and health systems. Big Pharma Lawsuits: Three pharmaceutical companies – Jazz Pharmaceuticals plc, Lundbeck LLC, and Alexion Pharmaceuticals, Inc. – have agreed to pay a total of $122.6 million to resolve allegations that they violated the False Claims Act by paying kickbacks to Medicare and Civilian Health and Medical Program (ChampVA) patients through purportedly independent charitable foundations. Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, has the latest news on this major story. The IRF Countdown Continues: The Inpatient Rehabilitation Facility (IRF) countdown to Oct. 1, 2019 will end with the change to use quality indicators for case-mix group (CMG) for payment calculation. Reporting this story is one of the nation’s foremost IRF authorities, Angela Phillips, president of Images & Associates and longtime RACmonitor editorial board member and Monitor Mondays panelist. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Targeted probe-and-educate (TPE) reviews by the Medicare Administrative Contractors (MACs) give providers and suppliers three changes to get it right or they’re out. If there are continued high denials after the first three rounds of reviews, the provider is referred to the Centers for Medicare & Medicaid Services (CMS) to determine additional disciplinary action – either extrapolation, referral to the Zone Program Integrity Contractor (ZPIC) or Unified Program Integrity Contractor (UPIC), referral to a Recovery Audit Contractor (RAC), suspension of Medicare payments, or even revocation of Medicare billing privileges.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, managing partner of Wachler and Associates. Wachler offers some practical tips and strategic approaches for responding to TPE audits to reduce claim denials.The broadcast rundown also will include:Developing Story: PIM Change: CMS is proposing major changes to the Program Integrity Manual (PIM) – changes that will take effect Jan. 1, 2019. Senior healthcare analyst Frank Cohen, director of analytics and business intelligence for DoctorsManagement, reports on the changes involving sampling and extrapolation.Death by Cyber: RACmonitor investigative reporter and New York attorney Edward Roche suffered a life-threatening medical emergency while in Barcelona, Spain. Roche reports on the one mainstay of America’s hospitals that was missing while he was hospitalized and ultimately experienced a complete recovery.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest with TPE audits.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.Register now for this important news broadcast coming up at 10 a.m. EST on Monday, Oct. 15.

RACmonitor was founded in 2008 to provide news and information for healthcare providers on the emergence of the government’s Recovery Audit Contractor (RAC) program. From a Centers for Medicare & Medicaid Services (CMS) demonstration in that year, and continuing to the national rollout in 2010 (coincidentally, the year of Monitor Mondays’ national debut), we have been reporting on activities not only of the RACs, but also the Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs), and the Quality Improvement Organizations (QIOs). But why, after nearly 10 years, do these auditors still tend to get auditing wrong? Providing insight into this issue during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, returns and reports on all the latest hot topics and the Monitor Mondays Listener Survey. News Update: RACmonitor national correspondent Timothy Powell reports on the move by UnitedHealthCare to adjust or deny emergency department (ED) claims submitted with levels four and five evaluation and management (E&M) codes. RACmonitor broke that story with Dr. Hirsch in December of last year. Auditing Report: Kristi Pollard, senior coding consultant at Haugen Consulting Group, reports on a top audit finding uncovered by her firm: discrepancies in secondary diagnosis assignment on outpatient claims. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron shares another example of a potentially troublesome issue that could pose a risk to your facility. Monitor with us™

On the rugged regulatory terrain, you might confront this issue: who bears the burden and blame of regulatory noncompliance when your facility relies on non-medical software companies that create electronic medical records? Many of these electronic records are self-populated. So, what happens if you undergo a Recovery Audit Contractor (RAC) audit and are accused of wrongdoing? Offering insight into this issue during the next edition of Monitor Mondays will be healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, who will be the broadcast's special guest. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest hot topics and the Monitor Mondays Listener Survey. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer will continue to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will report on a recent memo from the U.S. Department of Justice offering good news for some providers. Cyber Report: RACmonitor investigative reporter and New York attorney Edward Roche will report on risks associated with Apple's iPhone's new medical records portal. Roche is the director of scientific intelligence for Barraclough NY LLC. Monitor with us™

The six state medical societies of New England sponsored a webinar to inform physicians and medical office staff about a national auditing program that will impact health care providers. This session described the national Recovery Audit Contractor (RAC) program, a component of the Tax Relief and Health Care Act of 2006.  The goal of the [...]