Ask the expert: How can facilities prepare for the recovery audit contractor program?
HIM Connection, May 21, 2007
Want to receive articles like this one in your inbox? Subscribe to HIM Connection!
A: CMS' draft scope of work (SOW) for the national recovery audit contractors (RACs) was out for comment until April 9. Providers can expect a final document within 90 days after that.
Keep in mind that RACs cannot randomly select claims or target one "solely because it is a high-dollar claim," according to the draft SOW. 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."
"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 not consistent with Medicare payment policy
Editor's note: Thomas A. Hase, CMS spokesperson, provided the above answer. This Q&A is adapted from an article that appeared in the May 2007 issue of Briefings on Coding Compliance Strategies. For more information, click here.
Want to receive articles like this one in your inbox? Subscribe to HIM Connection!
Related Products
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Topic: CMS, OESS post new security compliance review information, checklist
- What does case-mix index mean to you?
- Capturing all necessary codes for IUD insertion and removal can be challenging
- QA:Coding multiple initial infusions
- News and briefs: Oklahoma Osteopathic Association against residency bill change
- HIPAA Q&A: Level of encryption needed for email
- OB services: Coding inside and outside of the package
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- What does case-mix index mean to you?
- Q&A tackles coding questions about injections and infusions
- Joint Commission Center announces handoff communication solutions
- Inside best practice: Reduce patient falls with a stoplight
- Identify modifiable risk factors to prevent patient falls
- Searched