News: CMS publishes RAC improper payment vulnerabilities
Case Management Weekly, September 29, 2010
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CMS released two additional special edition MLN Matters articles to educate providers regarding vulnerabilities identified during the recovery audit contractor (RAC) demonstration project and to prevent the same problems from reoccurring.
CMS has now released three MLN Matters articles that address the following area of risk:
- No Documentation or Insufficient Documentation Submitted (July 12)
- Medical Necessity Vulnerabilities for Inpatient Hospitals (September 23)
- Diagnosis Related Group (DRG) Coding Vulnerabilities for Inpatient Hospitals (September 23)
Special edition article SE1027 provides inpatient hospital education regarding 17 RAC demonstration–identified medical necessity vulnerabilities. According to CMS, the vulnerabilities may have occurred because the submitted medical documentation did not contain sufficient, accurate information to:
- Support the diagnosis
- Justify the treatment/procedures
- Document the course of care
- Identify treatment/diagnostic test results
- Promote continuity of care among healthcare providers .
Source: Revenue Cycle Institute
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