Corporate Compliance

Q&A: Can RACs review a claim more than once?

Compliance Monitor, November 10, 2010

Q: Can a recovery audit contractor (RAC) review a claim more than once?

 A: The RAC can review a claim either through automated or complex review more than once. The exact claim line cannot be reviewed more than once but the RAC may review different claim lines in separate reviews. In addition, the RAC may conduct a DRG Validation review and then separately request documentation to complete a medical necessity review.

This week’s question and answer originally appeared on the Frequently Asked Questions section of the CMS website.

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