Regulatory issues: Recovery audit contractors and their impact on case management

Professional Case Management

Volumn 14, Issue 5, 2009, Pages 217-223

  Terra, Sandra M ^a  

^a Medical Data Analytics   (United States)

Author keywords

Audit; Claim data; Claim denial; CMS; RAC

Indexed keywords

ARTICLE; CASE MANAGEMENT; ECONOMICS; FINANCIAL MANAGEMENT; GOVERNMENT; HEALTH CARE QUALITY; HUMAN; INSURANCE; LEGAL ASPECT; MEDICAID; MEDICAL AUDIT; MEDICARE; ORGANIZATION AND MANAGEMENT; PROGRAM DEVELOPMENT; RETROSPECTIVE STUDY; UNITED STATES;

CASE MANAGEMENT; CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); CONTRACT SERVICES; HUMANS; INSURANCE CLAIM REVIEW; MEDICAID; MEDICAL AUDIT; MEDICARE; PROGRAM DEVELOPMENT; PROGRAM EVALUATION; RETROSPECTIVE STUDIES; UNITED STATES;

EID: 70349816748     PISSN: 15297764     EISSN: 15390675     Source Type: Journal    
DOI: 10.1097/NCM.0b013e3181b094fe     Document Type: Article

References (11)

1. Centers for Medicare & Medicaid Services (2005). The Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contract (RAC) initiative (SE0565). Retrieved January 9, 2008, from http://www.cms. hhs.gov/ MLNMattersArticles/downloads/SE0565.pdf
2. Centers for Medicare & Medicaid Services. (2006). Status on the use of Recovery Audit Contractors (RACs) in the Medicare program. In CMS RAC status document FY 2006. Retrieved January 11, 2008, from Center for Medicare & Medicaid Services Web site: http://www.cms.org
3. Centers for Medicare & Medicaid Services. (2007, December 14). Hospital groups criticize CMS responses to worries about recovery contractors. Medicare Report, 18(48).
4. Centers for Medicare & Medicaid Services. (2008). Recovery Audit Contractors (RAC). Retrieved October 25, 2008, from http://www.fbo.gov
5. Centers for Medicare & Medicaid Services. (2008, November). Recovery Audit Contract overview. Retrieved January 6, 2009, from http://www.cms.hhs.gov/ RAC/
6. Centers for Medicare & Medicaid Services. (2008). The Medicare Recovery Audit Program: An evaluation of the three year demonstration. Retrieved January 2009 from http://www.cms.hhs.gov/RAC/Downloads/ RAC%20Evaluation%20Report.pdf
7. Erde, B. J. (2006, February). Recovery Audit Contractors: is the honeymoon over? Retrieved January 6, 2009, from www.duanemorris.com/articles/ static/modern-healthcare-feb06.pdf
8. Himak, L. (2007), Beware of the RAC project. Advance for Health Information Professionals, 17(7), 22-24.
9. Legal note: Medicare Recovery Audit Contractors. (2007, October). AHA Notebook, 29(2).
10. Texas Hospital Association. (2007). Letter to Mr. Gillespie. In Recovery Audit Contractors (RACs) request for proposal (RFP) RFP-CMS-2007.0022. Retrieved January 9, 2008, from http://www.texashospitalsonline.org
11. Wisconsin Hospital Association. (2008). CMS Recovery Audit Contractors (RACs). Retrieved January 11, 2008, from http://www.wha.org