HHS finalizes changes to Medicare appeals procedures

AHA News Now

The Department of Health and Human Services today released a final rule that attempts to address the significant backlog in Medicare appeals by making certain procedural changes. Specifically, the final rule in some cases allows attorney adjudicators to hear appeals in lieu of Administrative Law Judges... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare, regulation

Court rejects HHS request to reconsider order to eliminate appeals backlog

AHA News Now

A federal judge yesterday rejected a request by the Department of Health and Human Services that he reconsider requiring the agency to eliminate within four years the Medicare claims appeals backlog pending at the administrative law judge level. A Motion to Reconsider “is not a vehicle to present a new... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

CMS provides more detail on new RAC contracts

AHA News Now

The Centers for Medicare & Medicaid Services has posted the statements of work for its new Medicare Recovery Audit Contractors, a map depicting the new RAC regions and contact information for each RAC. CMS in October awarded five new Medicare RAC contracts. Three contractors will perform post-payment... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

Court orders HHS to eliminate ALJ appeals backlog

AHA News Now

A federal judge yesterday ordered the Department of Health and Human Services to eliminate the backlog of Medicare claims appeals pending at the administrative law judge level within four years, granting summary judgment to AHA and three member hospitals in their case challenging HHS for failing to meet... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

AHA survey: 6 in 10 RAC-reviewed claims did not have an overpayment

AHA News Now

Hospitals participating in the AHA’s third-quarter 2016 RACTrac survey report appealing 45% of all Recovery Audit Contractor claim denials, with 60% found to have no overpayment. Hospitals also report that RACs cite inpatient coding error as the most common reason for complex claim denials, and three in... read more

Topic: Advocacy and Public Policy
Tag: RACs

AHA webinar Dec. 13 to review RAC policy updates, latest survey data

AHA News Now

Hospital representatives are invited to learn more about recent policy activities impacting the Medicare Recovery Audit Contractor program during a webinar Dec. 13 at 2 p.m. ET. AHA staff will provide an update on the Centers for Medicare & Medicaid Services’ award of new RAC contracts, the latest on... read more

Topic: Advocacy and Public Policy
Tag: RACs

CMS releases details on reopened hospital appeals settlement

AHA News Now

The Centers for Medicare & Medicaid Services today released details related to the reopened inpatient status claims settlement. While the reopened settlement appears similar to the 2014 offer, this time CMS will provide partial payment, equal to 66% of the net allowable amount of the claim, for pending... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

CMS awards new Medicare RAC contracts

AHA News Now

The Centers for Medicare & Medicaid Services today named its new Medicare Recovery Audit Contractors. Three contractors will perform post-payment review of Part A and B Medicare fee-for-service claims for all provider types other than home health/hospice and Durable Medical Equipment, Prosthetics,... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

CMS to detail hospital appeals settlement process in early November

AHA News Now

The Centers for Medicare & Medicaid Services will post details on its new hospital appeals settlement process in early November, and answer questions about the process during a Nov. 16 call, the agency announced today. For more information and to register for the call, click here. CMS last month ... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

Friday is final day to complete AHA RAC survey

AHA News Now

Friday is the last day that hospitals can submit data to the AHA’s quarterly RACTrac survey. The free web-based survey helps AHA measure the impact of Medicare's Recovery Audit Contractor program on hospitals and advocate for needed changes. For more information on the RACTrac initiative, visit ... read more

Topic: Advocacy and Public Policy
Tags: RACs, Medicare

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