Revenue Cycle

CMS revises selection criteria for RAC adjustment crossover claims and fully reimbursable Part B claims

Recovery Auditor Report, August 20, 2009

On August 7, CMS issued transmittal R1793CP to modify one aspect of the logic that the Part A shared system uses in marking claims as RAC adjustment claims for crossover purposes. CMS also modified the Common Working File logic used in association with 100% reimbursable Part B claims that contain denied service lines. The changes become effective January 1, 2010.
While this information is mostly for toward Fiscal Intermediaries and Medicare Audit Contractors, CMS may be sharing this information with providers as part of their effort to be transparent about their processes, says Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc.

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