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Budgets are tight, but it seems that many healthcare providers are aware that setting aside resources to prepare for RAC audits is non-negotiable.
HCPro’s Revenue Cycle Institute examined this concept as a part of its recent nationwide survey of RAC readiness. The study, which was released recently, garnered more than 700 participants from all four RAC jurisdictions. The respondents hailed from various size healthcare providers: 25% came from hospitals with fewer than 100 beds, another 25% came from hospitals with more than 400 beds, with the remaining 50% falling in between. Approximately 14% of respondents had taken part in the RAC demonstration project.
“Respondents seem to have their RAC preparations well under way, although it’s not surprising that they are struggling with resources to devote to preparation,” according to Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, and author of the “RAC Preparedness Benchmarking Report,” which details the full results of the survey. Read More→
HealthDataInsights has been approved by CMS to audit for inappropriate billing related to the use of modifiers -TC and -26 on Part B claims in all RAC Region D states.
The new issue is as follows:
- Global vs TC/PC. An overpayment exists when providers are reimbursed for global procedures and then receive additional reimbursement for technical (modifier TC) and/or professional (modifier 26) components for the same service.
To see an updated list of issues approved in your area, visit the Tools section of the Revenue Cycle Institute Web site, and download our chart of approved RAC issues.
HealthDataInsights (HDI) added another new issue approved for RAC audits in all region D states to its Web site.
The new issue is as follows:
- DMEPOS while patient is in a covered Part A inpatient hospital stay.
The Web site provides the following explanation of the new issue: Read More→
Healthcare providers in several states received their first RAC denials.
Connolly Healthcare, the Region C RAC for Florida, South Carolina and several other states, has been behind many of them.
One hospital in South Carolina reports having three claims denied. However, learning of those denials did not go smoothly. The hospital received a call in late October from Connolly regarding a denial letter the hospital never received. The RAC sent the original denial letter in early August, and although it was addressed to the hospital, it apparently had no specific contact person listed, and the hospital never received it. Read More→
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→
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