Click Here to view a replay of the "Surviving and Thriving in the Age of Healthcare Audit Accountability" Webinar!

In order for the Centers for Medicare and Medicaid Services (CMS) to combat fraud and abuse, one of the provisions of the Tax Relief and Healthcare Act of 2006 gave CMS the authority to engage with private contractors to create the Recovery Audit Contractor (RAC) program. These RACs review previously paid claims to ensure that the claims were paid consistent with CMS’ manuals, NCDs, and LCDs. They also refer to prior audits performed by the OIG, CERTs, and use internal data mining utilizing their own proprietary software programs.

If you missed the webinar on Thursday, Oct 28, 2010, click View Recording to see a replay of the Time Based CPT Services and New RAC Issues for Physicians Services webinar.

By listening to this webinar you will have a better understanding of time based CPT codes and RAC issues for physician services, including:

Are you struggling to research coding, payment, medical necessity and compliance rules related to the myriad reviews and issues from your Recovery Audit Contractor (RAC) or other investigators?  This article is designed to show you how to get to the most often-requested information as it relates to MS-DRG Validation and Medical Necessity Reviews.  Instructions apply to the Regulation & Reimbursement Suite or Audit & Revenue Resource Center unless otherwise noted.

The AHA reports that CMS' New Issue Review Board approved the first "medical necessity review" audits last week.  The  audits include eighteen types of inpatient hospital claims and one type of DME claim. Remember that the RAC's must post the issues on their websites before issuing Additional Documentation Requests.  CMS expects the RACs to post the new audits and begin issuing ADR's within the next two weeks.  So, watch the RAC websites.  For your convenience, the issue pages on the RAC websites are:

To assist customers with understanding issues being investigated by the Recovery Audit Contractor, MediRegs has launched a new set of resources.

RAC Issues Comparison Chart

On the left-hand navigation pane of the Coding & Revenue Resource Center, the Audit & Revenue Resource Center, and the Regulation & Reimbursement Suite, you will find a new RAC ISSSUES link. This sortable table outlines the types of issues being investigated by the 4 Recovery Audit Contractors.

One of the more difficult issues facing hospitals today is related to the timely claim filing rules associated with re-billing ancillary charges for denied inpatient stays.

Under the RAC demonstration project, CMS allowed hospitals to re-bill their RAC denied inpatient short stay hospitalization cases as outpatient claims. The UB-04 claim type used to submit these claims for benefits was the traditional 13x; and Medicare Part B hospital benefit policies dictated coverage of services and payments.

CMS and Congress will be focusing more on regulatory compliance matters in 2009 than they have in years, according to Brian Flood, managing director at KPMG. "You have a lot of activity going on in the next six months," he said during a recent American Bar Association teleconference.