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As Medicare Auditors Seek to Rein in Costs, Hospital Admission Decisions Are Under Microscope
Recovery Audit Contractors (RAC) out to identify improper payments made on claims for Medicare beneficiaries
The government has made extensive efforts to combat fraud in the Medicare and Medicaid programs, recovering a record $4.2 billion in fiscal 2012 from individuals and companies trying to cheat the system. One of the largest sources of recovered monies is the Recovery Audit Contractor (RAC) program.
The RAC program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments to health-care providers under fee-for-service (FFS) Medicare plans. The goal of the RAC program is to identify improper payments made on claims of health-care services provided to Medicare beneficiaries. Improper payments could be overpayments or underpayments. Hospitals have been hit by the audits, with recoveries reaching $3.6 billion since the national program launched in 2010, according to Centers for Medicare & Medicaid Services (CMS) data.1 About $895 million was reclaimed from just six states during the RAC Demonstration Project between 2005 and 2008.
Read the full story here:http://bit.ly/195Gvd9
Source:The Hospitalist
The Impact of Nurse Practitioner Attribution in Medicare Shared Savings ACOs
December 5th 2023Allowing nurse practitioners to serve as attribution-eligible providers for Medicare Shared Savings Program accountable care organizations leads to no change in hierarchical condition category risk scores and modest growth in attributed beneficiaries.
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Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
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Oncology Onward: A Conversation With Dr Debra Patt of Texas Oncology
August 1st 2023Debra Patt, MD, PhD, MBA, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for episode 2 of our newest podcast, "Oncology Onward: Conversations With Innovators and Changemakers in Cancer Care."
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HMO and EPO Insurance Plans More Likely to Promote Use of Biosimilars
November 21st 2023Health plan type highly influences the likelihood of biosimilar uptake, with low-flexibility insurance plans more likely to have patients who either switched to a biosimilar or were initiated on a biosimilar.
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What We’re Reading: UnitedHealth Lawsuit; Fentanyl Crackdown; Global Heat Deaths Increase
November 15th 2023A class action lawsuit was filed against UnitedHealth Group and a subsidiary for allegedly using an algorithm to deny rehabilitation coverage for seriously ill patients; US and China officials are finalizing an agreement to crack down on fentanyl; a study published Tuesday projected global heat deaths to increase by 370% if no action is taken against global warming.
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