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Regulatory MonitoringArchive for Auditing and assessment
DCS Healthcare has released its first CMS-approved issues for audits in Region A.
The three issues, including one new issue not yet approved in other RAC regions, are applicable to durable medical equipment (DME) suppliers in Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.
According to the DCS Web site, the issues include the following: Read More→
At this point, thanks to a three-year demonstration project and a plethora of available information available for providers, the healthcare industry generally knows what providers are up against in terms of RAC audits. Not that they’ll be easy to handle, but there’s a lot of information out there for providers to help them manage the process.
Unfortunately, comparatively few providers seem to know what to expect with Medicaid Integrity Program audits—which have already begun in many areas across the nation—and in many cases, information that could help them is lacking.
It’s important for hospitals to have a process in place regarding never events, says John Steiner, Esq., chief compliance officer at UK HealthCare in Lexington, KY.
“There are numerous support areas that need to figure out how to work together—risk management, compliance, legal, patient accounts, coding, etc.,” he says.
There are several steps providers can take to ensure they are prepared, Steiner says: Read More→
A new study shows Medicare’s policy against paying for hospital acquired conditions (HAC) will only save the $400 billion program $1.1 million to $2.7 million.
California researchers conducted the study, according to a Wall Street Journal article. The researchers studied discharge data from California Medicare beneficiaries in 2006, looking for six conditions the authors deemed definable, according to the article. Out of the total 767,995 cases, there were 828 cases of those conditions, and 26 would have been subject to lower payments.
Connolly, the RAC for Region C, approved several issues for North Carolina providers on September 10.
The following issues have been approved for outpatient hospitals and physicians in North Carolina:
- Untimed codes
- Once in a lifetime procedures
- Pediatric codes exceeding age parameters
- J2505: Injection, Pegfilgrastim, 6 mg
Connolly may also audit Durable Medical Equipment (DME) providers in North Carolina for Wheelchair bundling and Urological bundling.
The Office of Inspector General (OIG) will be searching for relevant information prudent to your hospital’s audit. This information is called evidence. To support your audit begin to collect four types of evidence before the OIG visits:
- Physical Evidence: Paraphernalia obtained through direct inspection of property, events, and people. (e.g., maps, photographs, illustrations, written summaries of observations, charts)
- Documentary Evidence: Created evidence including: spreadsheets, accounting records, contracts, invoices, letters, performance reports, and surveys.
- Testimonial Evidence: Information received through bias-free interviews and inquiries from individuals involved in the particular audit.
- Analytical Evidence: Collect analytical evidence through the verification of amassed information, facts, and data. Laws, legal and non-legal opinions, hospital standards, and past and present operations should all be compared to your analytical findings.
This week’s tip was adapted from The Healthcare Auditor’s Handbook, for more information about the book or to order your copy click here.
Are you looking for help writing your RAC appeal letters? If so, the Revenue Cycle Institute hopes you will find a sample appeal letter outline useful as you combat RAC denials.
Editor’s note: To view the sample tool, which is courtesy of RAC Report Advisory Board member Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City, click on “Tools” at the top of the Revenue Cycle Institute Web site.
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