09/18/2018

Recent RAC Monitor Articles

This edition includes articles on......

Recent RAC Monitor articles you may find informative...

When Should You Voluntarily Refund an Overpayment?

It can be difficult to know if you’re getting good advice from your lawyer, but here is a good test to evaluate how well your lawyer understands the law, and whether he or she is willing and able to give you the information you need to make informed decisions.  READ MORE

Humana Medicare Announces Peer-To-Peer Process Changes

Once a denial is issued, a P2P will no longer be an option.

An astute physician advisor recently brought to my attention a change to the Humana Medicare Advantage peer-to-peer (P2P) process. The announcement (which can be found at this link: https://www.humana.com/provider/support/publications/your-practice-newsletter/peer-review-process-changes) states that effective Aug. 1, a P2P with the “treating healthcare provider” will be requested prior to the plan issuing a medical necessity denial. Once a denial is issued, even if the patient is still hospitalized, a P2P will no longer be an option.  READ MORE