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RAC to resume audit activities

In letters mailed to suppliers and providers last week, Performant RAC provided notification that, per CMS authorization, certain medical review activities would again resume. Additionally, the notification provides an additional 30 days to submit discussion...

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Did the DME MAC reveal first codes up for post-pay review?

Earlier today in a Listserv announcement, CGS announced that the Jurisdiction B Medical Review department would begin complex post-pay service-specific reviews on two codes: L0650 and A4253. Both reviews are a result of data analysis that indicate Jurisdiction...

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OMHA Further Expands the Settlement Conference Facilitation Parameters

By Sandra Gauron, Audit and Appeals Coordinator In an effort to provide Administrative Law Judge (ALJ) backlog relief, CMS launched the Settlement Conference Facilitation (SCF) pilot program in July 2014.  SCF is an alternative dispute resolution...

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Alert: Postcard Disguised as Official OCR Communication

The Office of Civil Rights (OCR) has issued an alert, warning health care organizations of postcards being distributed and disguised as official OCR communications, claiming to be notices of a mandatory HIPAA compliance risk assessment.  The postcards...

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MACs Medical Review get official start date

Today, CMS released more details on the medical review program since announcing audits would resume on August 3. This week's CMS MLN Connects newsletter included the headline "MACs Resume Medical Review on a Post-Payment Basis". In the article, it...

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