Tip: Watch out for RAC target areas
APCs Insider, March 27, 2009
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Recovery audit contractors (RAC) cannot randomly select or target a claim "solely because it is a high-dollar claim," according to the RAC Statement of Work. A RAC can only "target a claim because it is a high-dollar claim and contains other information that leads the RAC to believe it is likely to contain an overpayment."
According to Nancy Hirschl, president of Hirschl and Associates in Laguna Niguel, CA, that "other information" could include the following:
- A procedure code listed in an OIG report about services that are often not medically necessary
- A diagnosis code that a RAC believes, based on knowledge from work in the private health insurance arena, facilities may incorrectly code
- A provider with a high utilization rate compared to other physicians or states
- A belief that the claim payment was inconsistent with Medicare payment policy
Editor's note: This tip, from The RAC Report, was excerpted from HCPro's Revenue Cycle Management Toolkit: A Comprehensive Guide to Managing Cash Flow.
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Related Products
Most Popular
- Articles
-
- The positive aspect of change
- Practice the six rights of medication administration
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Differentiate between types of wound debridement
- What to include on the incident report
- OB services: Coding inside and outside of the package
- Complications from immobility by body system
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Q&A: Primary, principal, and secondary diagnoses
- E-mailed
-
- Challenges of antibiotic stewardship in the ICU
- Know the medical gas cylinder storage requirements
- Tip: Coding for inpatient postoperative complications requires explicit documentation
- Capturing start and stop times for infusions
- Bill and charge for supplies correctly to reduce risk and minimize lost revenue
- Hold a.m. and p.m. bed huddles daily
- Get the facts on coding for non-biodegradeable drug delivery implants
- Five keys to creating a CHF disease management program
- Eye flush is included in E/M facility code
- Ensure proper payment from interrupted stays
- Searched
-
- Creating a Successful Modern Telehealth INVALIDem
- sepsis present on admission
- why ambulation is requer for elderly people
- discharge summary
- Shared governance A practical approach to transfor
- Alzheimers disease and disorder
- Improved communication in facility construction co
- medical executive
- out patient history and physical
- Ethics answers