Health Information Management

CMS issues new RAC FAQ, video

HIM-HIPAA Insider, April 20, 2010

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On April 13, CMS released the following new RAC FAQ:

Q: Can the RAC do a medical necessity review on a claim that it originally reviewed for DRG validation?
 
A: At this time, if the RAC has already requested documentation and issued a review results letter to the provider for a DRG validation, the RAC will not be allowed to re-review the claim again for medical necessity. However, if both issues are approved (DRG validation and medical necessity) prior to the request of the additional documentation, the RAC may conduct both reviews simultaneously.
 
In addition, CMS recently released a RAC 101 presentation, available via YouTube at www.youtube.com/watch?v=IHFXsfP99Bc.
 
To view an updated list of RAC-approved issues in your state, visit the Revenue Cycle Institute Tools Web page.



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