The Medicare Recovery Audit Contractor Program


Book Description

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




Medicare Recovery Audit Contracting


Book Description

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 Primer


Book Description

This report provides a general overview of the Medicare program including descriptions of the program's history, eligibility criteria, covered services, provider payment systems, and program administration and financing.







Health Care Fraud and Abuse


Book Description

Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.







Senate Document


Book Description







Program Integrity


Book Description




Health Insurance Today - E-Book


Book Description

Learn to comprehend the complexities of health insurance! Using a reader-friendly approach, Health Insurance Today, A Practical Approach, 6th Edition gives you a solid understanding of health insurance, its types and sources, and the ethical and legal issues surrounding it. This new edition incorporates the latest information surrounding ICD-10, the Patient Protection and Affordable Care Act, and other timely federal influencers, as it guides you through the important arenas of health insurance such as claims submission methods, the claims process, coding, reimbursement, hospital billing, and more. Plus, with hands-on UB-04 and CMS-1500 (02-12) case studies on Evolve, you will come away with a clear understanding and working knowledge of the latest advances and issues in health insurance. CMS-1500 (02-12) software with case studies gives you hands-on practice filling in a CMS-1500 (02-12) form electronically. What Did You Learn? review questions ensure you understand the material already presented before moving on to the next section. Imagine This! scenarios help you understand how information in the book applies to real-life situations. Stop and Think exercises challenge you to use your critical thinking skills to solve a problem or answer a question. Clear, attainable learning objectives help you focus on the most important information and make chapter content easier to teach. Chapter summaries relate to learning objectives, provide a thorough review of key content, and allow you to quickly find information for further review. Direct, conversational writing style makes reading fun and concepts easier to understand. HIPAA tips emphasize the importance of privacy and following government rules and regulations. NEW! Updated content on the latest advances covers the most current information on Medicare, Electronic Health Records, Version 5010, and much more. NEW! Expanded ICD-10 coverage and removal of all ICD-9 content ensures you stay up-to-date on these significant healthcare system changes. NEW! UB-04 software and case studies gives you hands-on practice filling out electronic UB-04 forms. NEW! UNIQUE! SimChart® for the Medical Office case studies gives you additional real-world practice.