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audits

CMS contractor expands phone demo

 - 
11/04/2016

JACKSONVILLE, Fla. – C2C Innovative Solutions, the contractor handling the second level of the Medicare appeals process, has received the green light from CMS to expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.

New RACs and new rules

 - 
Wednesday, November 2, 2016
Elizabeth Hogue
attorney

CMS has selected five new recovery audit contractors (RACs) and established new rules. RAC audits will undoubtedly resume soon. Performant and Cotiviti were awarded contracts, along with HMS Federal Solutions.

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CMS taps Performant for nat’l RAC for DME

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11/02/2016

WASHINGTON – CMS has tapped Performant Recovery to perform post-payment reviews of Medicare claims for DMEPOS and home health/hospice nationwide.

Reporter's notebook: Right hand, left hand

Cover yourself in more ways than one, says Greene
 - 
07/25/2016

As if the sheer quantity of audits wasn’t enough to contend with, HME providers often have to untangle inconsistencies in regulations and guidance, says Stephanie Morgan Greene, a healthcare attorney who’s executive vice president of business development for AC

CMS revises scope of review on redeterminations and reconsiderations

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05/13/2016

WASHINGTON – CMS has expanded the limits on the scope of review for redeterminations and reconsiderations to include complex prepayment audits, AAHomecare has announced.

GAO pokes holes in CMS’s MA audit program

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05/10/2016

WASHINGTON – The Government Accountability Office isn’t pleased with CMS’s progress in recovering substantial amounts of improper payments from Medicare Advantage organizations.

Audits: Use two-tier approach

Q. We received our audit results, which include a large amount of money owed to Medicare based on an extrapolated overpayment! What do we do now?
 - 
04/20/2016

A. To reduce or remove the extrapolation, you will need to appeal the overpayment determination, addressing both the individual claims reviewed in the audit and the extrapolation itself. Consider this a two-tier appeal process.

Regulatory review: Suspensions, overpayments and exemptions

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04/15/2016

WASHINGTON – From a regulatory perspective, the first several months of 2016 have brought pain, and a little bit of relief, to HME providers.

Tool provides first look at severity of audits

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04/14/2016

WASHINGTON – Twelve percent of HME claims for new patients, on average, were subject to MAC prepayment audits in the fourth quarter of 2015, according to data collected through AAHomecare’s HME Audit Key.

HIPAA audits could catch providers off guard

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03/25/2016

WASHINGTON – With the Office of Civil Rights gearing up for phase 2 of its HIPAA Audit Program, HME providers could be doing a better job of protecting patient information, legal experts say.

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