HFMA NEWS

In its most recent update of recovery audit contractor (RAC) appeals, the Centers for Medicare & Medicaid Services (CMS) reported that the RAC demonstration program has corrected more than $1.03 billion of Medicare improper payments. Approximately 96 percent of those payments were overpayments collected from providers; the remaining 4 percent were underpayments repaid to providers.

From the inception of the RAC demonstration through June 30, 2008, providers appealed only 19.6 percent (102,705) of the RAC determinations; of those appealed, 34.9 percent (35,819) were decided in the provider’s favor.

As of June 30, there are an additional 1,607 claims (valued at $12 million) pending. Access the report.

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was announced Sept. 29 by the Centers for Medicare & Medicaid Services (CMS).

The rule guides states who wish to allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train, or fire their own personal care workers. Beneficiaries could also hire qualified family members who may already be familiar with the individual’s needs to perform personal assistance (not medical) services.

The notice of final rule is published in today's issue of the Federal Register. The final rule will be effective Nov. 3, 2008. Download the final rule.

As of Nov. 1, healthcare organizations will be required to have in place a policy on identity theft, under the Fair and Accurate Credit Transactions Act of 2003 (FACTA).

The law requires every financial institution--and creditor that holds any account for which there is a reasonably foreseeable risk of identity theft (including hospitals)--to develop and implement a written identity theft prevention program. The program must include reasonable policies and procedures for detecting, preventing, and mitigating identity theft, including identifying relevant patterns, practices, and specific forms of activity that are “red flags” signaling possible identity theft (such as unusual account activity, fraud alerts on a consumer report, or attempted use of suspicious account application documents); detecting and responding appropriately to any red flags that are detected; and ensuring the program is updated periodically to reflect changes in risks from identity theft.

Though FACTA doesn’t target the healthcare industry, it is clear hospitals and other healthcare organizations that collect huge amounts of identifying personal information must address identity theft for the protection of their customers, as well as the enterprise.

According to the rule, creditors have the opportunity to design and implement a program that is appropriate to the size, complexity, and nature of their business. Read the Federal Trade Commission alert. Read more in the September 2008 issue of hfm magazine.