News: Region B RAC posts first set of medical necessity issues
Case Management Weekly, August 18, 2010
CGI Technologies and Solutions, Inc., of Fairfax, VA, the Region B recovery audit contractor (RAC), recently posted the first set of approved medical necessity issues on its website. This occurred days after the American Hospital Association announced that CMS approved the initial review audits.
Providers have been waiting for the approved issues since spring. During a May CMS Open Door Forum call, a CMS representative said that CMS had received but not yet approved medical necessity issues.
“This is very consistent with the pattern we’ve seen with RACs since the roll out of the permanent program,” says Michael Taylor, MD, senior medical director of government and regulatory affairs at Executive Health Resources in Newtown Square, PA. “CMS has been very deliberate in vetting the subjects that RACs are allowed to review.”
Eighteen issues for medical necessity review were posted on the CGI website, and all but one of them comes as no surprise, according to Taylor.
Read more at the Revenue Cycle Institute
Related Products
-
Briefings on Accreditation and Quality
Briefings on Accreditation and Quality will help you with all of your accreditation and survey preparation needs. Every...
-
Case Management Monthly
This newsletter offers case studies, best practices, and how-to analysis to help case managers move patients through the...
-
Managing Complex Cases: A Study Guide for Case Managers
Designed especially for case managers--this resource provides innovative and field-tested strategies that will help case...
-
The CMS Survey Coordinator's Handbook
There is no reason to struggle with CMS requirements. HCPro has teamed up with former contracted CMS surveyor Jeff Coleman...
-
Avoidable Day Analyzer
Discover why avoidable hospitalization days occur, who's responsible for them, and how to tackle the problem head on with...
Most Popular
- Articles
-
- Practice the six rights of medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Don't forget the three checks in medication administration
- Code diagnoses and outpatient treatment for PTSD
- Differentiate between types of wound debridement
- OB services: Coding inside and outside of the package
- Q&A: Primary, principal, and secondary diagnoses
- What to include on the incident report
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Understanding and coding for critical care services
- E-mailed
-
- Q&A: Charging for drug administration during urgent care visit
- Neurological checks for head injuries
- HIPAA Q&A: Maintenance of medical records after physician death
- Ensure compliance with EPA rule: Ban all sewering of hazardous waste drugs
- Dig into the details of wound care documentation
- Differentiate between types of wound debridement
- Critical Test and Critical Result Reporting
- Coding tip: Learn the difference between nasopharyngoscopy and endoscopy procedures
- CMS replaces clinic E/M visit levels with single G-code
- Clear up confusion surrounding observation services
- Searched
