Key RAC Resources

Have you noticed one of the newest features in the MediRegs Coding Suite of products? Under Special Searches on the right hand side tool bar is now a direct link to RAC Issues. Key RAC Resources may be found here, including a direct link to CMS’s RAC information, Region A and B’s index of issues (Mediregs is attempting to secure permission from Regions C and D to post the issues listed on their respective websites), and a summary of RAC issues.

Users may click on an arrow to sort the list alphabetically or by region. Clicking on the index of issues brings the user to the specific RAC Region’s index, which is a sortable table by issue, approval date, status or claim/provider type. Additional information on a specific issue can be brought up by clicking on the issue number. From there, specific information on the issue can be found, with the affected states, a description of the issue and links to related resources (direct links to the RAC issues page pertinent OIG or CMS pages as appropriate).

For example, one of the issues listed for RAC Region B is MDC 04: Diseases and Disorders of the Respiratory system – MS-DRG 166, 167, 177, 178, and 179. The issue is defined as “The purpose of MS-DRG Validation is to determine that the principal diagnosis and all secondary diagnoses identified as CCs and MCCs are actually present, correctly sequenced, and coded. When a patient is admitted to the hospital, the condition established after study found to be chiefly responsible for occasioning the admission to the hospital should be sequenced as the principal diagnosis. The other diagnosis identified should represent all (MCC/CC) present during the admission that impact the stay. The POA indicator for all diagnoses reported must be coded correctly. Reviewers will validate for MS DRG 166,167,177,178, and/or179, principal diagnosis, secondary diagnosis, and procedures affecting or potentially affecting the DRG.”

This example affects claim/provider types of Inpatient Hospital, and includes the following states: IL, IN, KY, MI, MN, OH and WI. Links are given for the OIG’s Memorandum on Monitoring the Accuracy of Hospital Coding, The ICD-9-CM Official Coding Guidelines (specifically to the Selection of Principal Diagnosis), and the OIG’s DRG 79 Validation Study Update on Respiratory Infections and Inflammations.

Need even more information? A direct link to CGI Federal’s website is also provided. With all of this information at your fingertips, Mediregs Coding Suite of products is a great first stop when researching RAC issues.

Written by: Kathy Lindstrom, RHIT