Training Programs
Audits & Assessments
Regulatory MonitoringAuthor Archive
Oct
15
The Revenue Cycle Institute has released a new White Paper, “Inpatient or Outpatient Only: Why Observation Has Lost Its Status,” by Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc.
To download the free white paper, visit the Revenue Cycle Institute Web site and click on "White Paper."
Oct
15
CMS issued the following new RAC FAQ on its Web site September 30:
If I am a chain provider whose FI is WPS (serving as the national fiscal intermediary) who will my RAC be?
In addition, CMS updated the following question on September 25:
I heard that RAC medical record request limits will be based on my 2007 claims volume, then I heard on 2008. Which is it?
Oct
15
CMS planned a town hall meeting for November 5 from 1-3:30 p.m. Eastern Time to discuss appeals of Medicare payment denials under Section 935 of the Medicare Modernization Act.
To pre-register for the conference call, e-mail medicareoverpayments@cms.hhs.gov. CMS will release more information about the meeting in the coming weeks.
Oct
15
HealthDataInsights (HDI) has announced two new issues for region D. HDI can now audit DME providers in all region D states for the following two issues:
- Urological bundling
- Wheelchair bundling
For more information on these issues, visit the HDI Web site.
As always, the latest RAC issues for each state are posted on the Revenue Cycle Institute ”Tools” Web page. Simply click the link at the top of the page to download a chart of RAC activity in your state.
Oct
01
The Revenue Cycle Institute has released a new White Paper, “Sepsis and Septicemia: Clear Up Coding and Documentation Confusion,” by Jennifer Avery, CCS, CPC, CPC-H CPC-I, regulatory specialist for HCPro, Inc.
In addition, each month the Revenue Cycle Institute publishes a free sample tool or form for readers. We hope you find this month’s tool helpful—an incident to audit checklist, courtesy of Elin Baklid-Kunz, MBA, CPC, CCS, the director of physician services for Halifax Health in Daytona Beach, FL, and JustCoding.com.
Both are free to download via the Revenue Cycle Institute Web site. To download the free White Paper, visit the Revenue Cycle Institute Web site and click on “White Papers.” To download the free tool, click on “Tools.”
Oct
01
CMS released the following new RAC FAQ September 25:
Q: How long is the RAC discussion period?A: The discussion period begins with the time of notification (demand letter for automated reviews and the review results letter for complex reviews) through the time recoupment occurs. The discussion period normally requires written notification to the RAC. The discussion period does not extend the provider's appeal time frames.
Sep
17
We’ve gathered the latest RAC information on the CMS-approved RAC issues in each state and put it together for you in a chart we hope you’ll find helpful.
Check back regularly; we’ll update the chart every time a RAC posts a new issue so you can always stay on top of the issues RACs may audit in your state as well as others in your region and across the country.
To view the chart, click on “Tools.”
Sep
17
CMS released on September 11 transmittal 302, which outlines the authority RACs, MACs, and other Medicare auditors have to apply exceptions to certain local coverage determination (LCD) clinically reasonable and necessary requirements. According to CMS, such exceptions should be rare and only under unusual circumstances.
The transmittal notes that during complex medical reviews certain auditors (e.g., MACs, RACs, and CERT) must apply LCDs made by fiscal intermediaries, carriers or MACs. However, in rare and unusual circumstances it may become necessary during such a review to apply an exception to the clinical criteria in applicable LCDs after a thorough review of the patient’s medical record and a comprehensive analysis of the evidence in medical literature.
Contractors other than RACs may apply an exception to either approve or deny a claim. RACs, however, may only use the exception not to deny the claim, according to the transmittal. Note also that exceptions may not be made for insufficient or missing documentation, and auditors may not make exceptions to national coverage determinations, MAC articles, or CMS manuals.
The changes are effective October 13.
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