Tag Archives: MACs

The Surveillance and Utilization Review Subsystem (SURS)

Predictive Analytics or Provider Profiling? Call it what you want, is your agency being monitored by CMS and/or state Medicaid etal? And, have you directly triggered an alert? Or, are physicians that sign orders for your agency patients being investigated? Should you be aware that your agency could trigger a PPS RAC, MAC, or Z-PIC […]

CODING 2012: ICD-10-CM is Upon Us Next Year

Agency leaders know that now more than ever, coding is driving payment and is a focus of audit by RACs, MACs, and Z-PICs. It is imperative that the primary diagnosis, primary secondary diagnosis, and sequencing of all codes clearly delineate the picture of the patient and his/her condition. The codes are the Table of Contents […]

RACs are Gearing Up to Audit Medicare Advantage, Part D, and MEDICAID

And yet another RAC audit… Section 1902(a)(42)(B)(i) of the Social Security Act requires states to contract with Recovery Audit Contractors (RACs) to identify underpayments and to recoup overpayments as part of the state plan. The Patient Protection and Affordable Care Act required the states to have contracted with one or more RACs by December 31, […]