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09 Mar

CMS greenlights Performant, Region 1 RAC audit activity to begin this March

Performant Recovery Inc., the Region 1 & Region 5 Recovery Audit Contractor, has announced they have received approval from CMS to begin audit activity. As reported in a previous Cain Health Alert, Performant hinted that they would resume work again this March during their Provider Outreach webinars. On Wednesday, March 8, the formal announcement was made […]

23 Feb

New Rules for Governing Medicare Appeals Released by CMS

  The Center for Medicare Advocacy recently released an article detailing meaningful changes in a new final rule issued by the Centers for Medicare & Medicaid Services (CMS). The article shares a number of concerns with the new regulations which apply particularly to the Administrative Law Judge (ALJ) level of review. “The new regulations stated […]

17 Feb

Performant, NGS update Providers on new RAC contracts, other details

This week, National Government Services (FI/MAC) and Performant Recovery Inc. (RAC), held two webinars to introduce themselves and explain the Recovery Audit process to Providers. The RAC Regions were re-aligned as a result of the new Recovery Audit Contractor contracts and work is scheduled to resume this quarter for Performant, prompting a re-introduction. The webinars […]

06 Jan

With ACA Repeal Uncompensated Care Would Increase by $1.1 Trillion

A new study has suggested that a repeal of the Affordable Care Act – even a partial repeal – could lead to a dramatic increase in uncompensated care.  The report, published by the Urban Institute, finds that the increased amount would reach $1.1 trillion over a ten-year period. “The newly uninsured would seek $88.0 billion […]

12 Dec

US Healthcare Spending Reaches $10k Per Person

A new report from the Office of Actuary at the Centers for Medicare and Medicaid Services reveals that healthcare spending grew to $3.2 trillion dollars in the United States in 2015. This comes out to about $10,000 per person, a growth of rate of 5.8%. According to the report, published on HealthAffairs, the Affordable Care […]

01 Nov

Vermont Moves To All-Payer System

The state of Vermont has announced it received preliminary approval for its planned “all-payer” health care system. Governor Peter Shumlin has pushed for this new model as a means of addressing the rising costs of healthcare. The all-payer model would hold healthcare costs at an increase of 3.5 percent over ten years, purportedly saving Vermonters […]

18 Oct

Geisinger Health Systems Refunds Over $400K

Since rolling out a program in November 2015 that guarantees patients will receive a level of compassion and kindness with their medical care, Geisinger Health Systems has paid out more than $400,000 in refunds. According to a story in The Daily Item, the ProvenExperience initiative could easily top half-a-million dollars by the time it reaches […]

18 Oct

Reexamining Readmission Timeframes

A recent study published in Health Affairs suggests that a seven-day readmission interval may be a stronger indicator of quality care than the current measurement of thirty days. The study examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for patients ages sixty-five and older in four states. “The hospital-level quality signal […]