Medicare Administrative Contractors (MAC) Fax Scam Alert

June 22, 2009 · Posted in Industry News · Comment 

A 06/18/09 update on the Centers for Medicare and Medicaid Services (CMS) Home Health, Hospice & Durable Medical Equipment Open Door Forum website indicates that CMS has become aware of a scam.  The scam entails the submission of faxes to practices from perpetrators posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax tells physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.

Medicare FFS providers, including physicians and non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using the address found in the download section of the website found at or .

Conveying RAC Review Determinations

June 17, 2009 · Posted in RAC · Comments Off 

If you’re questioning exactly how RAC review determinations are going to be conveyed, you should read this blog post by Carla Engle, MBA, whose background includes years of experience in hospital reimbursement and billing functions.  In the post, Engle clarifies how the Medicare Recovery Audit Contractors’ (RAC) review results letters and demand letters will notify providers of the determination and collection process. 

Processes are covered for

  • automated claim reviews
  • complex claim reviews (where medical records and/or additional documentation are requested and reviewed)

AOTA Advocates for Medicare Home Health Flexibility Act (HR 1094)

June 12, 2009 · Posted in Industry News · Comment 

According to the American Occupational Therapy Association (AOTA), current law limits the appropriate use of occupational therapy in the home health setting and negatively impacts outcomes for home health care recipients by barring clinically indicated and physician authorized services.

As an important step forward, newly proposed legislation would allow occupational therapists to conduct the initial assessment when there is a qualifying service on the physician order. This will allow home health agencies to more efficiently use their occupational therapists to meet patient needs.

Representatives John Lewis (D-GA) and Lincoln Diaz-Balart introduced legislation that would improve utilization of occupational therapy as a home health service under Medicare on February 13, 2009. The Medicare Home Health Flexibility Act (H.R.1094) is also actively supported by the National Association of Home Care and Hospice (NAHC), the American Speech-Language Hearing Association (ASHA) and was previously supported by the American Physical Therapy Association in the last Congress.

AOTA is working to build support for passage during the 111th Congress.

CMS Releases 14 New RAC FAQs

June 12, 2009 · Posted in Industry News, RAC · Comment 

The Centers for Medicare and Medicaid Services (CMS) recently released fourteen new Recovery Audit Contractor (RAC) responses to frequently asked questions.   Access the entire list of RAC FAQs at the CMS website.