The Centers for Medicare & Medicaid Services (CMS) conducted a three-year project to demonstrate the use of recovery audit contractors (RAC) in identifying Medicare improper payments and recouping overpayments. This report examined issues that arose during the demonstration project and CMS¿s efforts to address them in the national RAC program. It examines the extent to which CMS: (1) developed a process and took corrective actions to address vulnerabilities identified by the RACs that led to improper payments; (2) resolved coordination issues between the RACs and the Medicare claims admin. contractors; and (3) established methods to oversee RAC claim review accuracy and provider service during the national program. Charts and tables.

Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment

This book provides a comprehensive and approachable overview of Medicare under the Affordable Care Act. The author illustrates how the ACA addresses the long-term fiscal and demographic challenges facing Medicare, as well as the potential for Medicare to become a single-payer system.

Medicare Recovery Audit Contracting: Lessons Learned to Address Improper Payments and Improve Contractor Coordination and Oversight

To provide effective service in helping clients understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, Inc., it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2016 Edition of Medicare Handbook offers expert guidance on: Health Care Reform Prescription Drug Coverage Enrollment and Eligibility Medigap Coverage Medicare Secondary Payer Issues Grievance and Appeals Home Health Care Managed Care Plans Hospice Care And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am on Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get nursing and therapy services for my chronic condition? And more! The 2016 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions where advocacy problems arise, and those areas in which coverage has been reduced or denied And more!