Brace yourself and get ready for a rough ride. For over a year now, whenever the subject of medical necessity has been raised, the standard response from CMS has been “medical necessity is not being reviewed at the present time”, or close variations thereof. “At the present time” gave goosebumps to those who follow the RAC auditing program closely. The other shoe would fall, we just didn’t know when.
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Continue ReadingOn July 28, 2010, a U.S. District Court in the Southern District of California rendered a decision of monumental significance to all providers who may consider challenging a RAC Contractor for violating the law. The original lawsuit, filed by Palomar Medical Center on March 24, 2009, was the first lawsuit filed against a RAC. The regulation is not complicated on this issue. (Pss … Judge Benitez – Your Honor – didn’t you check out the CMS website? No? You never heard of it? Umm … Sir, that would be the “official government website” that spells out the regulations all providers have to live by.)
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Continue ReadingAs mentioned before, it is not in the interest of the RAC’s to report a physician for fraud. Why? The RAC’s get ZERO if they report for fraud…BUT if they retract funds paid to a Doc, they then get a percentage of that take. Make sense? How about this: As report in USA Today on [...]
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