Training Programs
Audits & Assessments
Regulatory MonitoringAuthor Archive
HealthDataInsights (HDI), added a new CMS-approved issue to its list for all RAC region D healthcare providers.
Providers in region D should now be ready for RAC audits of DME claims for the following issue:
- Infusion Pump Denied/Accessories & Drug Codes should be denied.
“When the infusion pump is denied, then the infusion accessories and infusion drug codes are also denied,” according to the Web site.
For more information, visit the HDI Web site.
To stay on top of the latest RAC-approved issues in your state, visit the “Tools” section of the Revenue Cycle Institute Web site and download the updated chart at the top of the page.
If you’ve been audited by a RAC–for example, perhaps you’ve received a demand letter in the mail indicating a RAC has denied one of your claims–we want to hear from you.
The first three providers to share their stories will receive a free audio conference from HCPro. E-mail editor Andrea Kraynak (akraynak@hcpro.com) if you have a story to share.
HealthDataInsights (HDI) added one new RAC issue to their CMS-approved list October 29. The new issue approved for RAC audits in Region D is for DME claims. The issue is as follows:
- PEN supplies more than one time a day.
“The description or the billing guidelines state parenteral/enteral nutrition codes are allowed once a day,” according to the HDI Web site.
The Revenue Cycle Institute has new membership program for healthcare organizations that face challenges managing Medicare rules and regulations. The program offers ongoing access to regulatory experts for analysis, guidance, and tailored on-site education for their revenue cycle teams. Read More→
As of September 18, all four RACs were conducting automated audits, according to an October 6 American Hospital Association (AHA) RAC program update. But only 16 of the 23 audits underway were on hospital outpatient claims, according to the AHA. (The others were therefore on physician and durable medical equipment claims.)
So unless your hospital is so very unlucky to have been selected as one of the first for an audit, chances are you still have time to make a few necessary tweaks and run a few tests on your RAC processes to help ensure you’re ready when RACs do begin auditing your facility.
Healthcare providers are finding themselves and their reimbursement claims accountable to more and more auditors as CMS steps up its Medicare and Medicaid auditing activities. And CMS is unlikely to decrease auditing for incorrectly paid claims anytime soon; it too is being held accountable—by the Office of Inspector General (OIG).
In 2010, the OIG plans to review the progress of many Medicare and Medicaid auditing programs, as well as CMS’ oversight of several of the programs, according to the 2010 Work Plan, released October 1. Read More→
CGI, the RAC for Region B, has posted three new issues for review in Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin. This means CMS has now approved issues for RAC auditing in all states.
The new issues approved for physician and outpatient hospital claim review in these states are:
For more information on these and other issues approved for Region B states, visit the CGI Web site.
The Revenue Cycle Institute has issued a report on a nation-wide survey of hospitals about their efforts to prepare for the permanent RAC program. More than 700 hospitals nationwide participated in the survey.
While 71% of hospitals responding said they have a formal RAC preparedness program in place, the majority of programs were still in the early stages of development, focusing on initial attempts to complete risk assessments. Slightly under half of hospitals responding have designated a RAC coordinator. Most facilities have or are building RAC teams within their facilities, and the majority of those teams include a physician advisor in some capacity.
Get blog updates in your e-mail
Subscribe to our free RAC Report e-zine
