Medicare’s Recovery Audit Contractor (RAC) program has started with Connolly Healthcare, the RAC for a large part of the southern U.S., posting the first set of issues eligible for review.
Although the issues are approved for providers in South Carolina, get ready, providers. Experts say it’s likely RACs in other jurisdictions will pick up on them and consider them for review. Read more
There are few things you need to know about RACs, CMS' audit police, as explained in a recent PEARLS column:
1. If you bill Medicare, you can be audited.
2. RACs are more likely to look at high-dollar services and aberrant billing patterns.
3. Don’t rush a response to a RAC request. You’ve got 45 days to review your coding and documentation.
4. You should appeal a RAC decision if you feel it was incorrect.
For five more things you should know about RACs, finish reading the PEARLS column and check out Pamela Moore's recent column on the topic.
Thursday, August 6, 2009
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These first issues are the automated issues- stuff they can find with a computer like billing for two hysterectomies, doing two colonoscopies in one day, billing for Neupogen by the number of mg given not the number of vials, etc. The real fun comes later when they start looking at whether patients should have been admitted to the hospital rather than Observation or if the hospital billed for an inpatient stay for an ICD placement or cardiac cath when Observation status was more appropriate. These will be very subjective determinations and will earn the RAC's lots of money with each denial.
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