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Regulatory MonitoringArchive for Auditing and assessment
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.
Revenue cycle managers constantly search for the perfect benchmark information to compare their team’s work with others.
Don’t search too hard, says Michael S. Friedberg, FACHE, CHAM, associate vice president of patient access services for Apollo Health Street, a national revenue cycle solutions firm in Bloomfield, NJ.
It can be good to compare nationally or even regionally, but some of the best benchmarks are right under your roof. Read More→
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.
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.
New issues for RAC Region D
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.
CMS plans appeals town hall meeting
CMS has 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. CMS will release more information on the call in the coming weeks. Stay tuned for the latest information.
RACs have begun auditing at this point, and providers in some states may have received their first denial letters this week. But many providers seem to still be waiting, holding their breath, and worrying whether the mail carrier might deliver their first RAC demand letter(s) that day.
However tempting it may be to simply wait, providers can still use this time effectively. Consider the following tips from several RAC experts: Read More→
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