Many of you found the blog even though I misguided you! Many of my emails communicated the wrong link so thanks for getting here through your own navigation!
Please pass the word along that this blog does not have the traditional "www" in front of it, which was my mistake. It is simply: http://azcasemanagement.blogspot.com
Thanks for letting your friends and collegues know!
-Steve
Monday, July 28, 2008
Monday, July 21, 2008
Article Series: RACS and Case Management- First Article!
RACS and Case Management
Here it Comes: Permanent CMS RAC Audits Expanding to a State Near You
By Randi Ferrare for the Arizona Case Management Blog
July 21, 2008
Unless you have been comatose in an intensive care unit, you’ve heard horror stories about the CMS RAC (Recovery Audit Contractor) demonstration project that, along with the real estate market, has been wreaking havoc for the last three years in Florida, California and New York.
This unbounded, wildly successful program has allowed CMS to recoup “overpayments” totaling close to $1 billion dollars, resulting in Congress passing a permanent CMS audit process to roll-out to all states by 2010.
The “RAC” will be called the “MAC” (Medicare Administrative Contractor).
During the demonstration project period, I made many Hospital Administrators and Board of Directors aware of the urgency and reality of the CMS RAC audit program during presentations.
Often to lighten the somber mood in the room, I pointed out that the RAC audit program does have a silver lining to its unprecedented 40%-45% denial rate of reviewed medical records. That silver lining is the CMS Trust Fund.
The CMS Trust Fund ensures that monies spent by the generations following baby boomers into retirement, will be replenished with money that has been recouped from “unnecessary hospitalizations”. Hopefully to ensure that our subsequent generations will be able to collect Social Security benefits, as our parents and grandparents have.
Much to the dismay of hospital CFOs everywhere, the RAC program is expanding and can’t be avoided. As stretched as it is today with the ever growing debt of charity care and costly medical advancements in technology coupled with the physician demands for this latest technology, the healthcare dollar will only go so far. For the lucky few who have been able to have even the slightest positive bottom line, this program is a real threat and can’t be taken lightly.
For the hospitals on the front line during the RAC Audit program in the demonstration states, they are weary yet enlightened. Weary with all the added work, expense, staffing challenges and multiple process changes to deal with the audit. Enlightened because they are ahead of the curve.
For the hospitals that are yet to be part of the program, the task of preparing can be downright frightening.
To help get brought up to speed, there is a 62-page document titled, “ The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration” available from CMS. You’ll find this document on the CMS website (located at http://www.cms.hhs.gov
). It contains a wealth of information, both good and bad. It is quite an impressive document, examining what worked, what didn’t, and what changes are in store for the permanent “MAC” program.
At the very least, take a quick look and thumb through it. To help your Hospital join the “enlightened” forward on the Executive Summary to your “powers that be”.
Click here to access a copy of The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration:
http://ohcci.com/docs/RAC_Demonstration_Evaluation_Report.pdf
Here it Comes: Permanent CMS RAC Audits Expanding to a State Near You
By Randi Ferrare for the Arizona Case Management Blog
July 21, 2008
Unless you have been comatose in an intensive care unit, you’ve heard horror stories about the CMS RAC (Recovery Audit Contractor) demonstration project that, along with the real estate market, has been wreaking havoc for the last three years in Florida, California and New York.
This unbounded, wildly successful program has allowed CMS to recoup “overpayments” totaling close to $1 billion dollars, resulting in Congress passing a permanent CMS audit process to roll-out to all states by 2010.
The “RAC” will be called the “MAC” (Medicare Administrative Contractor).
During the demonstration project period, I made many Hospital Administrators and Board of Directors aware of the urgency and reality of the CMS RAC audit program during presentations.
Often to lighten the somber mood in the room, I pointed out that the RAC audit program does have a silver lining to its unprecedented 40%-45% denial rate of reviewed medical records. That silver lining is the CMS Trust Fund.
The CMS Trust Fund ensures that monies spent by the generations following baby boomers into retirement, will be replenished with money that has been recouped from “unnecessary hospitalizations”. Hopefully to ensure that our subsequent generations will be able to collect Social Security benefits, as our parents and grandparents have.
Much to the dismay of hospital CFOs everywhere, the RAC program is expanding and can’t be avoided. As stretched as it is today with the ever growing debt of charity care and costly medical advancements in technology coupled with the physician demands for this latest technology, the healthcare dollar will only go so far. For the lucky few who have been able to have even the slightest positive bottom line, this program is a real threat and can’t be taken lightly.
For the hospitals on the front line during the RAC Audit program in the demonstration states, they are weary yet enlightened. Weary with all the added work, expense, staffing challenges and multiple process changes to deal with the audit. Enlightened because they are ahead of the curve.
For the hospitals that are yet to be part of the program, the task of preparing can be downright frightening.
To help get brought up to speed, there is a 62-page document titled, “ The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration” available from CMS. You’ll find this document on the CMS website (located at http://www.cms.hhs.gov
). It contains a wealth of information, both good and bad. It is quite an impressive document, examining what worked, what didn’t, and what changes are in store for the permanent “MAC” program.
At the very least, take a quick look and thumb through it. To help your Hospital join the “enlightened” forward on the Executive Summary to your “powers that be”.
Click here to access a copy of The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration:
http://ohcci.com/docs/RAC_Demonstration_Evaluation_Report.pdf
Friday, July 18, 2008
Article: Disease Prevention Called a Better Bet
Disease Prevention Called a Better Bet
Wellness Programs Yield Greater Returns, Report Finds
By Megan Greenwell
Washington Post Staff Writer Friday, July 18, 2008; Page B03
An ounce of prevention in community health programs could save states hundreds of millions in health-care costs, a new study has found.
The report from the Trust for America's Health, a nonprofit health advocacy group, found that programs encouraging physical activity, healthy eating and no smoking were a better investment than those concentrating primarily on treatment.
TO VIEW THE REST OF THIS ARTICLE, CLICK HERE:
http://www.washingtonpost.com/wp-dyn/content/article/2008/07/17/AR2008071700990.html?hpid=moreheadlines
Wellness Programs Yield Greater Returns, Report Finds
By Megan Greenwell
Washington Post Staff Writer Friday, July 18, 2008; Page B03
An ounce of prevention in community health programs could save states hundreds of millions in health-care costs, a new study has found.
The report from the Trust for America's Health, a nonprofit health advocacy group, found that programs encouraging physical activity, healthy eating and no smoking were a better investment than those concentrating primarily on treatment.
TO VIEW THE REST OF THIS ARTICLE, CLICK HERE:
http://www.washingtonpost.com/wp-dyn/content/article/2008/07/17/AR2008071700990.html?hpid=moreheadlines
Monday, July 14, 2008
Article Series on Medicare RACS to begin!
Hello Case Managers! I hope you had a great weekend!
As promised, the series of articles on Medicare RACS will begin soon! Please check back to the blog as our guest author, Randi Ferrare, will present a very thorough review on this topic!
Thanks, Steve
As promised, the series of articles on Medicare RACS will begin soon! Please check back to the blog as our guest author, Randi Ferrare, will present a very thorough review on this topic!
Thanks, Steve
Tuesday, July 8, 2008
Article: United Healthcare Cuts Jobs, Phoenix affected.
UnitedHealth Ends Options Suits, Cuts 4,000 Jobs (Update2)
By Avram Goldstein
July 2 (Bloomberg) -- UnitedHealth Group Inc. agreed to the biggest settlement of lawsuits involving backdated stock options and said the company would trim 4,000 jobs after its membership fell and expenses for providing medical coverage rose.
UnitedHealth, the largest U.S. health insurer, said today it would pay $912 million to end two class-action cases over grants of stock options to executives. The Minnetonka, Minnesota, company last year restated earnings dating to 1994 because of a backdating probe that cost former Chief Executive Officer William McGuire his job in 2006.
The company today cut its annual earnings forecast for the second time. Health insurers have reported higher expenses and lower profits, driving down the six-member Standard & Poor's 500 Managed Health Care Index by 47 percent this year. The worst may now be over, analysts said after UnitedHealth's announcement.
TO VIEW THE REST OF THIS ARTICLE CLICK HERE:
http://www.bloomberg.com/apps/news?pid=20601087&sid=aIr_f.FU0g1w&refer=home
By Avram Goldstein
July 2 (Bloomberg) -- UnitedHealth Group Inc. agreed to the biggest settlement of lawsuits involving backdated stock options and said the company would trim 4,000 jobs after its membership fell and expenses for providing medical coverage rose.
UnitedHealth, the largest U.S. health insurer, said today it would pay $912 million to end two class-action cases over grants of stock options to executives. The Minnetonka, Minnesota, company last year restated earnings dating to 1994 because of a backdating probe that cost former Chief Executive Officer William McGuire his job in 2006.
The company today cut its annual earnings forecast for the second time. Health insurers have reported higher expenses and lower profits, driving down the six-member Standard & Poor's 500 Managed Health Care Index by 47 percent this year. The worst may now be over, analysts said after UnitedHealth's announcement.
TO VIEW THE REST OF THIS ARTICLE CLICK HERE:
http://www.bloomberg.com/apps/news?pid=20601087&sid=aIr_f.FU0g1w&refer=home
Monday, July 7, 2008
NEWS Article: Bush delays Medicare fee cut for doctors
Bush administration delaying Medicare fee cut.
By JIM ABRAMS, Associated Press Writer Mon Jun 30, 7:56 PM ET
WASHINGTON - The Bush administration said Monday it will delay paying doctors for treating Medicare patients in early July to give Congress more time to block a scheduled 10.6 percent fee cut.
To read the rest of this article, click this link:
http://news.yahoo.com/s/ap/20080630/ap_on_go_co/congress_medicare;_ylt=AoUb94R2Okp3dA3hapMWZ7rVJRIF
By JIM ABRAMS, Associated Press Writer Mon Jun 30, 7:56 PM ET
WASHINGTON - The Bush administration said Monday it will delay paying doctors for treating Medicare patients in early July to give Congress more time to block a scheduled 10.6 percent fee cut.
To read the rest of this article, click this link:
http://news.yahoo.com/s/ap/20080630/ap_on_go_co/congress_medicare;_ylt=AoUb94R2Okp3dA3hapMWZ7rVJRIF
Subscribe to:
Comments (Atom)
Posts
