Corporate Compliance

Note: It’s here... Medical necessity RAC reviews

Medicare Insider, August 17, 2010

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

What would be more appropriate than rolling out medical necessity reviews on Friday the 13th!  Last week, most of us heard through AHA that these types of reviews had been approved by CMS and that RACs would soon announce their approved issues. Although CGI, the RAC for Region B, was the first to post their issues, all providers can expect the same announcement from their own RACs soon. Of note is that all of these MS-DRGs include both the DRG Validation and Medical Necessity review and half of them were previously approved as DRG Validation only.  This may give us some insight into what patterns RACs may be seeing when reviewing medical records for other issues.

Continue reading Debbie's note on the MedicareMentor Blog.



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