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Home Health & Hospice Week

Medical Review:

Contractors Gear Up To Find Fault With Your Claims

Published on Mon Mar 28, 2005

CMS names Recovery Audit Contractors.

If you receive a medical review request from someone you've never heard of, you'd better check to see if it's one of the newly named Recovery Audit Contractors before you pitch the letter.

The Centers for Medicare & Medicaid Services has named Diversified Collection Services Inc., Public Consulting Group Inc., HealthData Insights, Connolly Consulting and PRG-Shultz International Inc. as the RACs that will review claims for providers in California, Florida and New York starting in May (see Eli's HCW, Vol. XIV, No. 5).

The RACs will review claims that are at least one year old, and if they find mistakes, they can keep a percentage of the resulting recoveries, CMS says in a release. Some of the contractors in California and Florida will audit only Medicare Secondary Payor claims.

Critics say the RACs are glorified bounty hunters with a strong incentive to recoup money. The three-state demonstration mandated by the Medicare Modernization Act may spread nationwide, if successful.

CMS will hold an Open Door Forum on RACs "in the near future," it says.
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