Revenue Cycle

Recent RAC Activity

Recovery Auditor Report, April 15, 2010

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CGI adds two new issues for medically unlikely edits (outpatient and professional)

CGI, the RAC for Region B, added medically unlikely edits for outpatient and professional claims review to its CMS-approved list for providers in all Region B states.
View the new issues by visiting the CGI Web site.
 
HDI removes existing issue
 
HealthDataInsights, the RAC for Region D, has removed a RAC issue for all Region D states. The removed issue is Anesthesia care package E/M services.
 
In addition, HDI has revised the description for an existing RAC issue for all Region B states. The updated issue is as follows:
 
Acute hospital readmissions without condition code B4 or 42.
  • Previous description:  An improper payment occurs when two separate acute hospital claims are paid for a Medicare beneficiary who is discharged and re-admitted on the same day and for the same DRG and there is no B4 condition code on the second claim
  •  New description: An improper payment occurs when two separate acute hospital claims are paid for a Medicare beneficiary who is discharged and re-admitted on the same day and for the same DRG and there are no B4 or 42 condition codes on the second claim.

Stay on top of these issues by visiting the HDI Web Site.



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