Feb 1st, 2014
“Clean” claims are only as accurate as your trained coders. By Angela Clements, CPC, CEMC, COSC Software coding edits can be beneficial for a physician office or they can be harmful—it all depends on the end user. From my experience, the pros of software coding edits outweigh the cons. Pros: Software coding edits provide practices ...
In Audit
Jan 1st, 2014
Part 1: Handle private payer audits effectively and limit future risk. Editor’s Note: This is the first in a series of articles to give you practical advice on how to handle payer audits, minimize your exposure, and limit future audits. This month, we discuss private payer audits. In upcoming months, we’ll cover audits by federal, ...
In Audit
Dec 2nd, 2013
Providers aren’t the only ones spending more time digging up material for recovery audit contractors (RACs). Hospitals report rising rejections of claims connected to RAC audits. Some of those rejections have prompted the Centers for Medicare & Medicaid Services (CMS) to adopt new rules about observation care. Industry publication AHA News Now reports the American ...
In CMS
Mar 26th, 2013
If you receive a letter from a Medicare recovery audit contractor (RAC) regarding overpayment, don’t panic! You may think you only have two options: pay up or launch an appeal. There is another option, however, if you move fast (before a formal appeals process starts) and are certain the RAC is mistaken about the overpayments. ...
Dec 1st, 2012
By Amy Lee Smith, MBA, CPC, CPC-H, CPMA, CIA, CRMA  Preparing for, and responding to, recovery audit contractor (RAC) reviews can be intimidating. You can lessen the pain, however, by understanding Medicare billing and coding rules and requirements, and being proactive in implementing controls to ensure compliance. RACs Review Across the Nation Section 302 of ...