RAC Procurement Updates - New Contracts Under Pre-Award Protest

  • Margaret Klasa DC, APN BC
  • Dec 08, 2014
  • Comments

It is almost the end of the year and no new Recovery Audit Contractors (RAC) contracts have been awarded. The Centers for Medicare & Medicaid Services (CMS) has recently posted a RAC procurement update stating that as of November 4, 2014, the new contracts for Recovery Auditor Regions 1, 2, and 4 remain under a pre-award protest, which is expected to continue into late summer of 2015. The procurement process continues for Region 3 (Part A / Part B claim reviews), which includes Florida, Ten ...

A Review of Mohs Surgery Claims with Incorrect Coding May Reveal Fraud

  • Cindy Gallee, JD, RHIA, CHC
  • Dec 01, 2014
  • Comments

There are a number of ways a dermatology claim for Mohs surgery can be problematic. But even though there had been a focus on this type of surgery in past years by payers and Recovery Audit Contractors (RACs), legal activity against doctors who allegedly have fraudulently billed Mohs surgery claims has again surfaced, indicating that the issue is not yet resolved. 1 What this means for payers is that since Mohs surgery is a high volume and high expense procedure, it needs to be carefully review ...

Context to Showcase FWA Solutions at NHCAA Conference in Dallas, TX

  • Kate Armbruster
  • Nov 17, 2014
  • Comments

  Context 4 Healthcare Inc. will showcase its Fraud, Waste & Abuse (FWA) solutions as an exhibitor at the National Health Care Anti-Fraud Association (NHCAA) 2014 Annual Training Conference taking place November 18 - 21, 2014 at the Hyatt Regency Dallas in Dallas, TX. The NHCAA Institute for Health Care Fraud Prevention's Annual Training Conference (ATC) is the organization's premiere annual event, recognized industry-wide as the nation's leading health care anti-fraud forum. At Conte ...

Detect Unusual Patterns in Service & Patient Volume in All Specialties

  • Cindy Gallee, JD, RHIA, CHC
  • Nov 14, 2014
  • Comments

Payers should not neglect reviewing dental claims for fraud, waste and abuse. An Office of Inspector General (OIG) report released this month found questionable billing for pediatric dental services, including dentists who provided an aberrant number of services per day and dentists performing an unusual number of services per patient per visit. Also, the OIG found inappropriate billed claims for behavior management services. Though the findings are important for reviewing dental claims, they a ...

Big Change This Fall! MUE Allows 2 E/M Codes Billed for the Same Day

  • Margaret Klasa DC, APN BC
  • Nov 03, 2014
  • Comments

  In the past, Medicare has allowed only one Evaluation and Management (E/M) visit per day. Now, as of October 1, 2014, the Medically Unlikely Edits (MUE) allows you to report two medically necessary E/M visits per patient, per day. (Although until you receive notification from your Medicare carrier, it would be reasonable to follow existing coding guidelines.) There are episodes when a patient sees a provider in the morning and for a different problem unrelated to the first presents late ...

Subscribe to Our Blog:

Connect With Us


Proudly Affiliated with:

Proud_Members_Logo_250X100Affiliate with FedRAMP and AWSNational Association of Dental Plans Member