Revenue Cycle

Did you know . . . Five CMS RAC Open Door Forum facts

Patient Financial Services Weekly Advisor, April 17, 2009

According to CMS, as noted in the April 14 Medicare RAC Special Open Door Forum, the following are true of RACs:

  • On contingency fees: RACs receive the same contingency fee regardless of whether they identify over- or underpayments.
  • On medical record request limits: If your medical record request limit is per NPI, listen up. The record request limit is based on your group NPIs, not the number of NPIs assigned to your individual physicians. This could be an issue, explains Nancy Beckley, MS, MBA, CHC, of Bloomingdale Consulting Group, Inc. “An 18-member physician practice group that has a group NPI could expect requests of 60 medical records every 45 days, whereas if this same medical group issues a different group NPI to each of its three practice locations (each of which have six doctors), the physician practice group could have up to 30 medical records requested for each of the three groups—for a total of 90 medical records every 45 days.”
  • On line-item billing: For a claim containing multiple CPT codes for the same date of service, each code (i.e., procedure) constitutes an item that RACs can review. Beckley believes this may come as a surprise to many providers who may consider a visit (which could encompass several CPT codes) as a claim for a date of service.
  • On submitting electronic claims: The RACs currently aren’t set up to receive electronic data interchange—nor will they be for some time. For now, submit paper claims (via fax is fine) or send images of electronic medical records via CD or DVD.
  • On outreach sessions: If you are in a blue state, you will start seeing outreach sessions in your area beginning in August. If you are a yellow or green state, you should see sessions in your area soon. CMS will update its outreach schedule as it adds sessions. If you are a yellow or green state and believe CMS has no outreach sessions applicable to your organization in your area, e-mail CMS at RAC@cms.hhs.gov. CMS also plans to provide an outreach presentation on its Web site. CMS acknowledged during the call’s Q&A section that hospital associations and medical societies hosting the provider outreach sessions may have limited participation to “members only” leaving nonhospital or nonphysician providers (e.g., physical therapy clinics or DME providers) without an opportunity to attend a session, says Beckley.  

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