Posts Tagged ‘RAC’

Recovery Audit Contractors (RAC) HealthDataInsights (HDI) and CGI Federal have added to their list of new issues eligible for review as per the Centers for Medicare & Medicaid Services (CMS).

The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented in 2010 to detect and correct past improper Medicare payments.

Tip: Don’t wait until Jan. 1, 2010 to review these new issues and correct any problems your outpatient hospital or physician practice may uncover. Read more »

In reviewing the criteria required for Certification Commission for Health Information Technology (CCHIT) credentialing, the American Academy of Professional Coders (AAPC) uncovered multiple areas for concern. Many of the CCHIT requirements conflict with federal mandates for correct coding or with what AAPC promotes as appropriate coding principals.  Read more »

Connolly Healthcare, recovery audit contractor (RAC) for region C, recently updated its list of audit issues approved by the Centers for Medicare & Medicaid Services (CMS) and DCS Healthcare, region A RAC, posted new issues for the first time. The lists of issues under review give providers insight into what they should be looking for in their own internal audits. Read more »

CGI Federal’s first set of approved issues for Recovery Audit Contractor (RAC) review in Region B is now available.

Following HealthDataInsights and Connolly Healthcare’s lead, the approved issues target outpatient hospital and physician claims and include blood transfusions, IV hydration, and bronchoscopy services.

All three RACs will be looking for overpayments due to excessive units reporting. For blood transfusions, IV hydration, and bronchoscopy services, you should bill a maximum of 1 unit per patient, per date of service.

Look for additional information regarding these RAC-approved issues, including affected codes and policy-related links, on CGI’s Web site.

If audited, a provider has an initial discussion period to present additional information to support the services billed. If the provider does not agree with the decision, then the provider has 120 days from date of the First Demand Letter to file an appeal of the determination.

On Oct. 6, 2008, the Centers for Medicare & Medicaid Services (CMS) announced that CGI Technologies and Solutions, Inc. of Fairfax, Va., was awarded Region B, initially working in Indiana, Michigan and Minnesota and later adding Illinois, Kentucky, Ohio and Wisconsin.

CGI may be contacted by phone at (877) 316-7222 and by e-mail at racb@cgi.com.

Gearing up for the 2010 implementation of the Recovery Audit Contractor (RAC) program,  HealthDataInsights (HDI) and Connolly Healthcare are the first to post issues eligible for review.

The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented to detect and correct past improper payments so that the Centers for Medicare & Medicaid Services (CMS), claims processing contractors, and providers can take action to prevent future improper payments. Read more »

Don’t let internal audits lull you into a false sense of security. “Certainly, internal audit results can show where additional education is necessary to ensure appropriate coding, billing, and documentation practices,” says HealthLeaders Media in a July 30 report. “And this will result in fewer RAC denials, because if practices are correct, the RACs will find fewer errors to deny.

“But many providers also assume that reporting errors (and refunding identified overpayments) discovered while self-auditing will protect those claims from RAC review.”

Not so, says the Centers for Medicare & Medicaid Services (CMS).

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The rapid increase of ultrasound services nationwide has Medicare watchdogs on the alert. Health care practitioners who submit Part B claims for technical and professional ultrasound services can expect added scrutiny. A recent Office of Inspector General (OIG) report provides insight as to what Medicare Administrative Contractors (MACs) will soon be on the lookout for when reviewing imaging service claims.

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The Centers for Medicare & Medicaid Services (CMS) announced Feb. 6 that the permanent Recovery Audit Contractor (RAC) program is set to begin March 1. The bidding protests filed by Viant, Inc. and PRG Schultz, USA, Inc., which caused a Stop Work order in October 2008, are resolved.

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AAPC’s 2009 Workshops to Focus on Effective Coder-Physician Communication, Successful Audits and Correctness in Coding

Workshops will provide attendees with practice-centric tips, training and strategies

As part of its ongoing efforts to maintain the highest level of continuing education and to help its members stay abreast of the ongoing changes in the health care industry, the American Academy of Professional Coders (AAPC, www.aapc.com) announces the topics for its 2009 workshops. The workshops will be held quarterly in more than 60 cities nationwide. Read more »

The Centers for Medicare and Medicaid Services (CMS) completed its limited pilot of the Recovery Audit Contractor (RAC) program in March, and based on its success at collecting Medicare overpayments from providers, the RAC initiative will be taken nationwide beginning in 2009.

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