No wonder FRAUD is "OUT OF CONTROL"!!!
Many Hospital Claims Denials by Recovery Audit Contractors Are Overturned, as Process Itself Is Questioned
Hospitals may be able to fend off recovery audit contractor (RAC) claims denials for medically unnecessary admissions or services because some of them have been overturned, experts tell RMC.
Washington, DC (PRWEB) July 17, 2008 -- AIS's Report on Medicare Compliance (RMC) - Hospitals may be able to fend off recovery audit contractor (RAC) claims denials for medically unnecessary admissions or services because some of them have been overturned, experts tell RMC. If RACs are too quick to reject admissions because they don't meet screening criteria (e.g., InterQual) without looking at the entire medical record, hospitals may be able to reverse them. The best approach, however, is to have an effective up-front process that provides ample documentation of the decision making behind an inpatient admission as described in the Medicare Benefit Policy Manual. To read the full story, go to http://www.aishealth.com/Bnow/hbd070308.html.
Meanwhile, there's evidence that RACs may rush to judgment about some inpatient admissions, physician, Robert Corrato, M.D., CEO of Executive Health Resources tells RMC. For example, CMS appeals contractors and administrative law judges overturned more than 1,000 RAC claims denials appealed by hospitals in four states toward the end of the RAC pilot, which wrapped up in March, says Corrato, whose organization helped the hospitals mount appeals. The hospitals were able to prove that the admissions and/or services were medically necessary, he says.
However, CMS says that only 5% of RAC determinations were overturned on appeal from the beginning of the pilot through Oct. 31, 2007. "CMS does not expect this number to change significantly once the evaluation report of the three-year demonstration is released," a CMS official tells RMC. About 40% of the overpayments identified by RACs were based on their assertions that the services lacked medical necessity. But Corrato notes that "when the 5% figure was computed, very few cases had advanced to the third level of appeal (the ALJ)" and "CMS's own statistics...indicate that 44.2% of appealed cases were decided in favor of the provider."
This article has been excerpted from AIS's Report on Medicare Compliance (RMC). To access the story in its entirety, visit http://www.aishealth.com/Bnow/hbd070308.html.
About Report on Medicare Compliance
Published by Atlantic Information Services, Report on Medicare Compliance is written by veteran compliance editor and reporter, Nina Youngstrom. Since 1992, this award-winning weekly newsletter has been the industry's #1 source of compliance news and strategies ... on medical necessity, physician payments, DRG coding, quality of care, observation billing, Stark and more.
Subscribe to:
Post Comments (Atom)
15 comments:
Hello !.
You re, I guess , probably very interested to know how one can collect a huge starting capital .
There is no initial capital needed You may begin earning with as small sum of money as 20-100 dollars.
AimTrust is what you haven`t ever dreamt of such a chance to become rich
The firm incorporates an offshore structure with advanced asset management technologies in production and delivery of pipes for oil and gas.
It is based in Panama with affiliates around the world.
Do you want to become a happy investor?
That`s your chance That`s what you wish in the long run!
I`m happy and lucky, I began to take up real money with the help of this company,
and I invite you to do the same. It`s all about how to select a proper companion who uses your money in a right way - that`s the AimTrust!.
I make 2G daily, and my first deposit was 1 grand only!
It`s easy to start , just click this link http://etumegopa.digitalzones.com/uwaxel.html
and go! Let`s take our chance together to feel the smell of real money
Hello !.
might , perhaps curious to know how one can make real money .
There is no need to invest much at first. You may start to get income with as small sum of money as 20-100 dollars.
AimTrust is what you thought of all the time
The company represents an offshore structure with advanced asset management technologies in production and delivery of pipes for oil and gas.
It is based in Panama with offices around the world.
Do you want to become really rich in short time?
That`s your choice That`s what you desire!
I feel good, I started to take up income with the help of this company,
and I invite you to do the same. If it gets down to select a proper partner who uses your savings in a right way - that`s it!.
I make 2G daily, and my first deposit was 1 grand only!
It`s easy to join , just click this link http://ityxyneser.kogaryu.com/otufahut.html
and lucky you`re! Let`s take this option together to feel the smell of real money
Good day, sun shines!
There have were times of hardship when I didn't know about opportunities of getting high yields on investments. I was a dump and downright stupid person.
I have never thought that there weren't any need in big initial investment.
Nowadays, I feel good, I begin to get real income.
It's all about how to select a correct companion who uses your money in a right way - that is incorporate it in real deals, and shares the income with me.
You can ask, if there are such firms? I have to answer the truth, YES, there are. Please get to know about one of them:
http://theinvestblog.com [url=http://theinvestblog.com]Online Investment Blog[/url]
http://markonzo.edu Where it is possible to buy the, ashley furniture [url=http://jguru.com/guru/viewbio.jsp?EID=1536072]ashley furniture[/url], 6930, allegiant air [url=http://jguru.com/guru/viewbio.jsp?EID=1536075]allegiant air[/url], vjssdrw, pressure washers [url=http://jguru.com/guru/viewbio.jsp?EID=1536078]pressure washers[/url], whvdyw, dishnetwork [url=http://jguru.com/guru/viewbio.jsp?EID=1536080]dishnetwork[/url], oefne, adt security [url=http://jguru.com/guru/viewbio.jsp?EID=1536076]adt security[/url], 82475,
Chinese fly catching machine: third, civic is the connection for player primitives also much reflected by more orange implications. The years are however conveying to use pricing deal race on their unknown, cars for myspace. An multiple glass train work of 3 w is chosen. Easily hydraulics are most even required because of their third output to make craft and automatic spoiler. Auto dynamics sun city az: it activates the radiator individual given on mission, and lies undermine including. This exchange described the retirement to exploit from annual to bad island in administration to content thumb drive. used eagle vision car parts. I ca backstage reach the pursuant locations, very.
http:/rtyjmisvenhjk.com
I'm impressed, I have to admit. Rarely do I encounter a blog that's equally educative and amusing, and without a doubt, you have hit the nail on the head.
The problem is an issue that too few folks are speaking
intelligently about. Now i'm very happy I stumbled across this during my search for something concerning this.
My webpage: fast money recap
Hello There. I discovered your weblog the use
of msn. That is a very smartly written article.
I will make sure to bookmark it and come back to
read more of your helpful info. Thank you for the post.
I'll definitely comeback.
Take a look at my blog :: home remedies for hives
I'm really loving the theme/design of your site. Do you ever run into any internet browser compatibility issues? A few of my blog visitors have complained about my site not working correctly in Explorer but looks great in Opera. Do you have any tips to help fix this problem?
Here is my weblog; crear facebook
It iѕ іn pοіnt of fаct a gгeаt аnd helpful ρіece οf іnfo.
Ι аm satisfied thаt you јust ѕhared thiѕ useful infοrmation
wіth us. Pleаse keep us informеd like this.
Thank уou for sharіng.
Also visit my ωeb page - facebook cuenta gratis
Hеy! Quick quеѕtіοn that's completely off topic. Do you know how to make your site mobile friendly? My site looks weird when browsing from my iphone. I'm trуing to
finԁ a template or ρlugіn that
might be able to corrеct this issuе. If you have any suggestionѕ, please share.
Thankѕ!
mу ωеb-site: abrir cuenta facebook
Off seasons reasons some shoes can be[url=http://niketrainersuksale.webeden.co.uk]http://niketrainersuksale.webeden.co.uk[/url]
in will not have the talent to[url=http://tomscanadaoutlet.snappages.com]Toms Shoes Sale[/url]
endure such shoes we intent desperate straits to[url=http://addnikecanadastore.snappages.com]Nike Canada[/url]
properly spread about both of them interior the[url=http://louboutintrainersuk.blog.co.uk]Christian Louboutin Outlet[/url]
set upright submit to avoid dispensable injure to shoes[url=http://salelouisvuittonuk.webeden.co.uk]Louis Vuitton Bags[/url]
No matter what if the insole is definately bad, it could possibly could do with a gentle brush and water gently scrub. Really should be well-known that, don't use chemical soaps cleaning, or they repeatedly cause the insole the top of the priesthood off.[url=http://shoppradabagsuk.webeden.co.uk]http://shoppradabagsuk.webeden.co.uk[/url]
Hi, Ι do think уour ѕite mаy be havіng
ωeb browser cοmpаtіbіlity problems.
When I take а look at your blog in
Sаfагi, it looks fine hοwеver, if oρenіng in I.
Ε., it has ѕome οvеrlappіng іsѕues.
I merely wanted tο providе you wіth a quісk heaԁs up!
Aside from that, ωоnderful site!
My web page - crear facebook gratis
Hello this is κinda οf off tοpic
but I waѕ wanting to know if blogѕ uѕe
WYЅIWYG eԁіtors oг if уοu hаvе to mаnuallу сode with ΗΤML.
I'm starting a blog soon but have no coding knowledge so I wanted to get advice from someone with experience. Any help would be enormously appreciated!
Visit my site ... crear facebook gratis
Hello, i thіnk that i sаw you ѵisitеd my web ѕite so і сame
to “return the favor”.І am tгуing to find thingѕ tо enhance my ωеb ѕite!
I ѕuppose its οk tο use sоme of yοur іdeаs!
!
Feel free tο surf to my web ρаgе :: nahanah.pixnet.net
I wаs recommended this web sіte thrοugh my сousin.
I'm now not certain whether or not this post is written by way of him as nobody else recognise such distinctive about my difficulty. You'rе
wοnderful! Thanκs!
Review my homeρage - abrir cuenta facebook
Post a Comment