Medicare claims denial

Is a RAC Prepayment Review of Your Medicare Claims on the Horizon?

Medicare, Medicaid & Private Payor Updates /

(December 19, 2011): As you know, RACs play an important role in the identification of Part A and Part B overpayments. Since the inception of the RAC Demonstration Project in 2005, RACs have successfully identified a number of improper claims, denying payment for reasons ranging from mere technical errors to broad concerns about medical necessity. […]

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A CERT Audit Is Serious – Don’t Take These Medicare Reviews Lightly

Medicare, Medicaid & Private Payor Updates /

(November 23, 2011): The “Comprehensive Error Rate Testing” (CERT) program was implemented as a mechanism for the Centers for Medicare and Medicaid Services (CMS) to assess whether their Medicare Administrative Contractors (MACs) are properly paying claims. In other words, is a particular MAC failing to identify and deny improper claims? Alternatively, is the MAC denying

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