Tag: RAC audits

WASHINGTON - The Recovery Audit Contractor (RAC) has received approval to audit hospital beds and manual wheelchairs, according to a bulletin from AAHomecare. The issue names are “Hospital Beds: Medical Necessity and Documentation Requirements” and “Manual Wheelchairs: Medical Necessity and Documentation Requirements.”  These are both complex reviews and the RAC will be determining whether the items were reasonable and necessary based on the medical record. The RAC...

WASHINGTON - The national recovery audit contractor for HME has set its sights on ventilators, but that's no big surprise, industry stakeholders say.The Medicare Administrative Contractors are already auditing vents, and the Office of Inspector General has included the product category in past work plans.“I think it's a no-brainer for the RACs to say, 'Hey let's audit this, too,'” said Kim Brummett, vice president of regulatory affairs for AAHomecare.Performant Recovery announced in January...

Since it's been so long since HME providers have had to grapple with a RAC, stakeholders offered these pieces of advice:Be proactive. “Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the...

LIVERMORE, Calif. - Providers should strap in: After a protracted lull, RAC audits will likely pick back up in January, now that CMS has tapped Performant Recovery, based here, to perform post-payment reviews for DME and home health/hospice claims nationwide.Stakeholders say Performant will likely kick-start its efforts with reviews* it had previously been performing as the RAC for Jurisdiction A—reviews whose targets were everything from vacuum erection devices to respiratory assist devices...

WASHINGTON - Industry stakeholders say a Congressional hearing last week on audits is likely the first of many such hearings on the issue.“This hearing is part of taking a look at the recovery audit contractor (RAC) audits which the hospitals are fully engaged in,” said Jay Witter, vice president of government affairs for AAHomecare. “Their issues are our issues and they are really boiling up now.”Officials from the Center for Program Integrity, the Government Accountability...

WASHINGTON - A subcommittee hearing on audits yesterday shows that lawmakers are getting the message.“I have some serious concerns that the current system of post payment audits by recovery audit contractors (RACs) is resulting in a significant burden on some providers,” said Rep. Michelle Lujan Grisham, D-N.M., at a hearing held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements, according to a bulleting from The VGM Group.Officials...

BALTIMORE - Talk about a clawback. Some recent letters rescinding certain audits were sent in error, say stakeholders.What happened? Some providers apparently received letters from the DME MACs rescinding certain audits on power wheelchairs, support surfaces and prosthetics.Unfortunately, that was only partially correct.“The intent was that they meant to send out rescinds on certain power mobility, but they accidentally sent it on O&P and some other stuff,” said Wayne van Halem, president...

ATLANTA - A recent surge of audits in Jurisdiction C are targeting “low-lying fruit,” older claims that are more likely to have problems, say consultants.RAC auditor Connolly Healthcare in the past few months has focused audits on power wheelchair claims from 2009 and 2010.“Instead of randomly picking claims to see if providers are doing things correctly, they're really going back in time—thinking that if they go back (further) they have a better chance of recouping money,”...

YARMOUTH, Maine - More and more state Medicaid programs across the country are getting Recovery Audit Contractor (RAC) programs up and running.In Texas, for example, the state Medicaid program in June issued a request for proposals for a RAC to conduct audits. The contractor's expected start date: Sept. 1."We've already got cash flow concerns because of Medicare's audits," said Liz Moran, executive director of the Medical Equipment Suppliers Association (MESA), which represents providers in Texas....