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RACs Archives — Medicare-Medicaid Audit World

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Published By Dessen, Moses and Rossitto. February 8, 2013. Will CMS Double Down on the Success of the Recovery Audit Program? By David S. Dessen, Esq. According to CMS, between October 2010 and December 2012, the RACs collected $3.8 billion in overpayments. As the nearby chart makes clear. The Change to the Time in Which CMS Can Collect an Overpayment. In May 2012, the HHS-OIG released a report entitled “ Obstacles to Collection of Millions in Medicare Overpayments. The law passed to avoid the “fis...

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Will Recovery Audits Drive Away Medicare Providers? - Part I — Medicare-Medicaid Audit World

http://www.medicaremedicaidblog.com/2012/10/will-recovery-audits-drive-away-medicare-providers---part-i.html

Published By Dessen, Moses and Rossitto. October 16, 2012. Will Recovery Audits Drive Away Medicare Providers? 8211; Part I. By David S. Dessen, Esq. Will drive providers from the Medicare program, an analysis of the administrative costs incurred by providers as the result of Medicare program integrity activity is in order. With the exception of the data collected by the American Hospital Association (AHA) through its RAC Trac initiative. The RAC Trac Data. According to the American Hospital Directory.

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Does SECRETARY = MAC - Who Authorizes Statistical Sampling? — Medicare-Medicaid Audit World

http://www.medicaremedicaidblog.com/2012/09/does-secretary-mac---who-authorizes-statistical-sampling.html

Published By Dessen, Moses and Rossitto. September 5, 2012. Does SECRETARY = MAC – Who Authorizes Statistical Sampling? By David S. Dessen, Esq. In 1991, in the case of Chaves County Home Health Service Inc. v. Sullivan. The Court of Appeals for the District of Columbia Circuit approved the use of. In 935 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress added a new subsection (f)(3) to 42 U.S.C/ 1395ddd. Limitation on use of extrapolation. The meaning of this sectio...

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ZPICs Archives — Medicare-Medicaid Audit World

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Published By Dessen, Moses and Rossitto. September 21, 2012. Are All Providers Equal in the Eyes of the ZPICs? By David S. Dessen, Esq. The World of Medicare Contractors. By David S. Dessen, Esq. September 21, 2012. April 11, 2016 12:17 pm. August 22, 2012. Who are the Medicare Auditors? By David S. Dessen, Esq. According to Chapter 3. Of the Medicare Program Integrity Manual (PIM), in addition to their claims processing functions, Medicare Administrative Contractors (MACs) have the authority to review a...

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Does Medicare Always Have To Pay A Hospital For Services Provided? — Medicare-Medicaid Audit World

http://www.medicaremedicaidblog.com/2012/11/does-medicare-always-have-to-pay-a-hospital-for-services-provided.html

Published By Dessen, Moses and Rossitto. November 2, 2012. Does Medicare Always Have To Pay A Hospital For Services Provided? By David S. Dessen, Esq. On November 1, 2012, the American Hospital Association and four individual hospitals filed a lawsuit. Will CMS’ Broad Power to Administer the Medicare Program Defeat the Hospitals? There is no doubt that Congress has given CMS broad powers to enact rules and regulations governing the operation of the Medicare Program. CMS has used that. Authority to promul...

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Court Cases Archives — Medicare-Medicaid Audit World

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Published By Dessen, Moses and Rossitto. November 2, 2012. Does Medicare Always Have To Pay A Hospital For Services Provided? By David S. Dessen, Esq. On November 1, 2012, the American Hospital Association and four individual hospitals filed a lawsuit. Will CMS’ Broad Power to Administer the Medicare Program Defeat the Hospitals? There is no doubt that Congress has given CMS broad powers to enact rules and regulations governing the operation of the Medicare Program. CMS has used that. Authority to promul...

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Evaluation and Management Codes - The Newest Audit Target — Medicare-Medicaid Audit World

http://www.medicaremedicaidblog.com/2012/10/evaluation-and-management-codes---the-newest-audit-target.html

Published By Dessen, Moses and Rossitto. October 1, 2012. Evaluation and Management Codes – The Newest Audit Target. By David S. Dessen, Esq. Reports on Evaluation and Management Billing. In May 2012, the HHS OIG released a report entitled “ Coding Trends of Medicare Evaluation and Management Services. On September 15, 2012, the Center for Public Integrity released a study entitled “ How doctors and hospitals have collected billions in questionable Medicare fees. From the Secretary of Health and Human Se...

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Palomar Medical Center v. Sebelius - Update — Medicare-Medicaid Audit World

http://www.medicaremedicaidblog.com/2012/09/palomar-medical-center-v-sebelius---update.html

Published By Dessen, Moses and Rossitto. September 11, 2012. Palomar Medical Center v. Sebelius – Update. By David S. Dessen, Esq. In a July 21, 2012 post I discussed the case of Palomar Medical Center v. Sebelius. Which raised the question of whether the “good cause” requirement set forth in 42 CFR 405.986(a). In a unanimous decision. In my July 24th post I discussed the decision in St. Francis Hospital v. Sebelius. In which a District Court in the Eastern District of New York came to a contrary result&...

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OIG Archives — Medicare-Medicaid Audit World

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Published By Dessen, Moses and Rossitto. February 8, 2013. Will CMS Double Down on the Success of the Recovery Audit Program? By David S. Dessen, Esq. According to CMS, between October 2010 and December 2012, the RACs collected $3.8 billion in overpayments. As the nearby chart makes clear. The Change to the Time in Which CMS Can Collect an Overpayment. In May 2012, the HHS-OIG released a report entitled “ Obstacles to Collection of Millions in Medicare Overpayments. The law passed to avoid the “fis...