CMS recently provided direction to A/B MACs and QICs regarding the scope of appellate review for redetermination (1st Level) and reconsideration (2nd Level) appeals of certain claims. Historically, MACs and QICs had discretion while conducting …..
A Hospital’s commitment to effective statutory and regulatory compliance starts at the top with the Hospital’s Governing Board. On April 20, 2015, the Office of Inspector General, U.S. Department of Health and Human Services (“OIG”) …..
RACs, ZPICs and other appeals: Timelines, Recoupment, and Accrual of Interest. Byline: J. Stuart Showalter Routine internal and external auditing of Medicare claims is a critical step in avoiding denials and managing audits effectively when …..
CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” – REDUX You may recall earlier this year, CMS issued a Transmittal giving MACs, RACs, CERT contractors, and ZPICs discretion to automatically …..
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has begun its second phase of audits (Phase 2 Audits) of compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) …..
CMS Provides MACs, CERT, RACs, and ZPICs with Automatic Denial Authority for “Related claims” Effective March 6, 2014, CMS amended the Medicare Program Integrity Manual giving MACs, RACs, CERT contractors, and ZPICs discretion to automatically …..
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