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Healthcare Law

Medical Necessity and RAC Audits

Medical Necessity and RAC Audits What is a medical necessity? According to a RAC Auditor (RA), it is something that is justifiably reasonable and necessary according to evidence-based clinical standards of care. According to who? Is this one-size fits all? How is this even possible? If you are not scratching…
Healthcare Law

Home Healthcare Medicaid Denials

Home Healthcare Medicaid Denials If you are a Georgia Home Healthcare service provider, then, you will need to pay close attention to this article especially as it pertains to nutritional counseling.  The State government is scrutinizing this type of service and the related billing. For example, if a claim for nutritional…
Healthcare Law

CMS Audits Home Health Agencies

CMS Audits Home Health Agencies Determining Provider Compliance with Home Health Quality Reporting Program Requirements Section 1895(b)(3)(B)(v)(I) of the Act states that ‘‘for 2007 and each subsequent year, in the case of a home health agency that does not submit data to the Secretary in accordance with subclause (II) with…
Healthcare Law

Medicare RAC Program Audit

Medicare RAC Program Audit Medicare Recovery Audit Contractors (RAC) Congress created RAC to help identify improper Medicare payments. RAC auditors are private contractors paid a commission by the government to: Identify overpayments or under payments Recoup overpayments or return underpayments Unfortunately, bounty-hunter-like incentives cause physician practices undue hardship, expense and time away…

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