http://www.washingtonwatch.com/bills info@washingtonwatch.com http://www.pjdoland.com/chai/?v=0.1 http://www.washingtonwatch.com/bills/show/110_HR_4105.html#41014 While most of the attention has been focused on acute inpatient providers, SNFs also have something to worry about. If a patient was transferred to a SNF and the acute care stay was deemed medically unnecessary, the SNF will be denied reimbursement as well.... 41014@http://www.washingtonwatch.com Mon, 25 Aug 2008 12:51:02 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#40049 If done correctly and managed appropriately, RAC will thrive while educating the provider community of the best approach in billing and coding -- however, the way this was structured i.e., contingent fees, uncertified coders and nurses makes it hard for the public to trust this si going to work and will truly benefit this country.... 40049@http://www.washingtonwatch.com Mon, 11 Aug 2008 22:45:40 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#39085 Help me out here....hospitals have to pay to appeal, even if they win the appeal?... 39085@http://www.washingtonwatch.com Thu, 17 Jul 2008 13:00:54 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#38875 Don't be fooled by the provider community-- of course they oppose an audit of overpayments that were made to them! This project saves hundreds of millions of dollars for US taxpayers-- period.... 38875@http://www.washingtonwatch.com Thu, 10 Jul 2008 13:51:48 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#38476 The RAC auditors are learning coding guidelines as they audit. Many of them are nurses who don't have experience in coding. Making judgements on weather or not a chart is coded correctly. However, there are alot of cases that are truly coded incorrectly, due to inexperienced hospital coders and managers. These should definitley be scrutinized. I think the RAC program is could provided they use qualified and accurate auditors.... 38476@http://www.washingtonwatch.com Sun, 29 Jun 2008 07:37:54 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#35651 People should be informed that MDs receive NO training on billing in Medical School, nor in internships, residencies, or fellowships. What can and cannot be billed for is the domain of medical billers, who ARE trained in this area. MDs rely on billers' knowledge of Medicare rules and laws when bills are submitted. Despite this reality, Medicare investigations for criminal fraud make MDs their primary target. An increasing number of MDs are now being indicted on felony fraud charges, for obscure violations of Medicare rules that even their professional billers were unaware of. Unlike prosecutions of the Government's OWN illegal activities, which target the lowest persons on the totem pole, Medicare prosecutions target those thought to be at the top, such as physicians, rather than the those who were actually responsible for the mistakes.... 35651@http://www.washingtonwatch.com Sun, 25 May 2008 18:27:05 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#35648 Physician providers don't "fight" many denials because it's often too costly to fight. Medicare billing rules on coverage 7 non-coverage are impossible for physicians themselves to decipher. In many cases, they're impossible for trained billing professionals to decipher as well. Such obfuscation is not by accident -- it is by design. It enables Medicare to deny payments for a plethora of reasons, while falsely maintaining that only physicians determine "medical necessity." In reality, it is non-medical people who determine "medical necessity," by using minor technicalities to deny payment -- effectively overruling a physician's determination of medically necessary care. Worse still, if physicians receive payment for alleged non-medically-necessary care, they can be criminally prosecuted for doing so.... 35648@http://www.washingtonwatch.com Sun, 25 May 2008 18:08:24 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#35643 The government now launches unjustified criminal investigations of physicians, using warrantless searches in violation of the 4th Amendment, now justified by the trumped up "war-on-terror." Physicians are now indicted on felony criminal charges for minor billing errors, while tacking on additional, fabricated charges to increase the penalties for conviction — including prison sentences. I know this from personal experience. I'm an MD facing a possible prison sentence, after being indicted for a minor billing error committed by a biller, which I was completely unaware of, and which cost Medicare $0.00.... 35643@http://www.washingtonwatch.com Sun, 25 May 2008 17:15:02 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#35642 The government has markedly stepped up its witch-hunt on individual physicians. The government now launches investigations on physicians, using warrantless searches in violation of the 4th Amendment, thanks to trumped up "war-on-terror." They are indicting physicians on criminal charges for minor billing errors, while tacking on additional, fabricated charges to increase the penalties for conviction — including prison sentences. I'm speaking from personal experience, as an MD facing a possible prison sentence, for a minor billing mistake by a biller, which I was completely unaware of.... 35642@http://www.washingtonwatch.com Sun, 25 May 2008 17:07:13 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#35390 Considering the CERT program found 6 - 20 % error rate in medicare claims and the RAC only found .5% in this short program tells me there are many more errors to be found. Why wouldn't the goverment audit the largest govement program and save taxpayer money. The hospitals and doctors have been being overpaid for the last 40 years.... 35390@http://www.washingtonwatch.com Thu, 22 May 2008 01:57:25 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#33908 Karen I believe some of the % used are misleading to Congress -- CMS calculates the turnover on appeals to be 5% because they are measuring it against all Medicare payments, not just those that the RAC identified overpayments.... 33908@http://www.washingtonwatch.com Mon, 05 May 2008 15:02:11 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#32840 This is duplication of services. The CMS Fiscal Intermediary should be auditing charts as they already do. I do not see the need for the RAC. Even the FI has flaws my organization is currently experiencing an 80 success rate on appeals. The RAC process will only add to administrative costs and ultimately contribute to esaclating health care costs. I hope this legislation is passed.... 32840@http://www.washingtonwatch.com Wed, 23 Apr 2008 16:25:11 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#32568 Our hospital spends alot of time appealing the RACs as well. These "overpayments" are mainly level of service denials. We have found quite a few that do not follow the Medicare guidelines and are wrongly being declared as overpayments. The RACs have too much incentive to deny these claims.... 32568@http://www.washingtonwatch.com Fri, 18 Apr 2008 14:01:45 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#31645 Our company spent the last year appealing and won every claim but it cost far more than we saved. Medicare 'banks'on that fact, and that is why the RAC collects so much money. It takes a lot of dogmatic energy to appeal 1000 separate appeals in a month or two. Its a full time job. The audits were based on very stupid ideas which were computer genertaed and violated the RAC audit contract (California). We did not have any income to support the cost, and it may yet close our company.... 31645@http://www.washingtonwatch.com Sun, 23 Mar 2008 17:25:30 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#31455 umm. Karen the REAL information is that off all audited claims, providers have chosen to FIGHT ONLY 11%, OF WHICH 50% ARE REVERSED IN FAVOR OF THE PROVIDER.... 31455@http://www.washingtonwatch.com Sat, 15 Mar 2008 13:17:03 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#31392 Get the REAL information http://www.cms.hhs.gov/RAC/Downloads/2007%20RAC%20Status%20Document%20vs1.pdf Almost half of the overpayments were the result of incorrect coding that DOES NOT comply with Medicare's Coding or Medical Necessity policy and rules. Only 5% of RAC determinations are overturned on appeal. The RACS identified and corrected $371 million in improper Medicare payments in 2007, $303.5 million in 2006. During the demonstration, the RACs only had to pay back the contingency fee if they lost at the first level of appeal. This has been changed to all levels of appeal for the permanent program. $674.5 million is an awful lot of taxpayer money. Imagine the amount of taxpayer dollars saved when this program is implemented for all 50 states.... 31392@http://www.washingtonwatch.com Wed, 12 Mar 2008 21:52:11 EDT http://www.washingtonwatch.com/bills/show/110_HR_4105.html#28765 I hope this bill goes thru. RAC's make their determinations soley to their own standards ignoring Medicare rules and standards. As a result they show a lot of findings of which many are won at appeal by the hospital. And guess what; the RAC still gets paid for the "find" even though it was overturned. The hospital pays out on legal fees, the FI must work the appeal while Medicare pays the cost of the appeals process and the RAC sits back and collects their fees. These guys have nothing to lose by making bogus claims against the hospital instead of doing an honest days work. They have to go, replaced by a more reasonable, fairer system of checks and balances.... 28765@http://www.washingtonwatch.com Tue, 15 Jan 2008 14:59:04 EST http://www.washingtonwatch.com/bills/show/110_HR_4105.html#28557 Amount of government/ hospital waste is unbelievable. I hope this Bill is NOT signed into law.... 28557@http://www.washingtonwatch.com Mon, 14 Jan 2008 15:10:49 EST http://www.washingtonwatch.com/bills/show/110_HR_4105.html#26128 I am for revising the proposal so that hospitals would not suffer financially from this audit exercise. There are points to gain to ensure that the Medicare trust fund is safeguarded and hospitals operate efficiently. Monitoring the work of the contractors effectively as stated in the bill would help alleviate the effort to ensure profitability is not abused.... 26128@http://www.washingtonwatch.com Wed, 02 Jan 2008 20:46:35 EST http://www.washingtonwatch.com/bills/show/110_HR_4105.html#23295 With the final contract RAC's cannot go back earlier than October 07. Fraud and abuse will be controlled and more money will go to those who are in real need. The budget will be under control without having to raise taxes. I hope this Bill will not be signed into law.... 23295@http://www.washingtonwatch.com Sat, 17 Nov 2007 01:53:40 EST http://www.washingtonwatch.com/bills/show/110_HR_4105.html#23047 Recovery Audit COntractors have been given authority and financial incentive to arbitrarily demand repayment for medical services extending back four years. If this program goes national, hospitals will close and physicians will opt out of Medicare making access to healthcare much more difficult. RAC's are profit driven private companies who got their contracts through powerful political connections. I hope this Bill is signed into law.... 23047@http://www.washingtonwatch.com Sun, 11 Nov 2007 14:04:49 EST