Training Programs
Audits & Assessments
Regulatory MonitoringArchive for RACs
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.
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.
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.
OIG issues Work Plan
On October 1, the OIG issued its Work Plan for FY 2010.
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→
Get blog updates in your e-mail
Subscribe to our free RAC Report e-zine
