Revenue Cycle

Combat potential undercoding due to fear of RAC denials

Recovery Auditor Report, March 18, 2010

Although many providers have tried to curb undercoding over the years, the flurry of activity from Recovery Audit Contractors (RAC) during the last few months has contributed to a proliferation of coding inaccuracies of this nature.
“There’s been a general tendency to undercode at some facilities for a while now. I just think it has gotten worse with fear of RAC audits,” says Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc., in Marblehead, MA. “That’s not what CMS intends. They intend for us to be reimbursed correctly for what we do.”
Hoy sees missing charges and undercoding so frequently that she believes most hospitals are underpaid. “We miss so much at hospitals because we aren’t sure how to bill for it or are afraid we will receive denials and be accused of fraud,” Hoy says.
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