RAC Nightmare Continues for Providers

Rene Letourneau, for HealthLeaders Media , September 16, 2013

Provider Must Be 'Vigilant'
Kim Looney, partner at Nashville-based law firm Waller, says provider organizations should pay close attention to HHS' annual Work Plan, which outlines new and ongoing reviews and activities that the Office of Inspector General plans to pursue throughout any given fiscal year.

"They release the plan every year, and it sets out what they are going to focus on," Looney says, stressing that providers need to know what is contained within the Work Plan. "That is part of being proactive. You can't ever let your guard down."

"[Providers] have to be so diligent and vigilant," she adds. "They have to be educated to know what the guidelines are, and if they change, they have to be aware of it."

Looney says it is important for providers to appeal denied claims for financial reasons, but also for the principle of the matter.

"You almost have to keep fighting or there is no reason for the RAC not to try to continue to take money back," she says. "If no one is going to argue with the RAC, they are going to keep denying claims."

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3 comments on "RAC Nightmare Continues for Providers"

Jeff Angel (9/23/2013 at 8:17 PM)
This will continue until organized medicine makes a stand. I dont know why we are cowering down to cms and auditors over this blatant money grab from hard working people. We all need to just say no!!!!!! MPHs need to help us figure this out[INVALID][INVALID]penalizing hard workers with post audits when we dont know rules is one of yhe most stressful things in medicine. Another reason for smart kids to go into medicine. If we have surgeons in 20 years it wi be a miracle!!!!!

Ronald Hirsch (9/19/2013 at 2:53 PM)
RAC's claim they are fighting fraud and that RACTrac data is faulty and self-selected http://goo.gl/Yf6GJU yet they have only found 8 cases of fraud in 7 years. Irony at its best

daniel dulnikowski (9/16/2013 at 8:20 PM)
We were hit with three a few months ago. Two Breast Cancer patients, and an Ovarian Cancer patient. All had Lymphedema, and needed compression pumps. I looked and the paperwork and it was all solid. One had already be fought to the ALJ level, and won. We submitted our paperwork, and LOST. Two of these patients shoudl be covered under the Women's Cancer Health Act of 1998. But they were denied anyway. If they can do it to these patients, they can do it to anybody.




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