Revenue Cycle

From The Field: RAC experiences

Recovery Auditor Report, April 15, 2010

 An anonymous reader shared with us their RAC experience, and had this to say:

We’ve now had four DRG validation request letters come in: 
  • First batch had 39 records requested, but one was not allowed because the account was excluded per the RAC data warehouse. Six of these had DRG changes, one an underpayment and five overpayments. We used the discussion period for one particular case, but they did not agree with our argument and it was not changed. We haven’t received any demand letters to date.
  • Second batch had 12 records requested, but four were incorrectly selected. The RAC used the old DRG numbers when the accounts were paid under the new MSDRG, i.e. – They requested records for MSDRG 468, which is not on the approved target list. We’ve gotten a few results letters back, but some are still pending.
  • Third batch was rescinded because it was sooner than the 45-day period.
  • Fourth and final batch had 49 records requested, but one does not need to be sent, since a CERT had previously reviewed it. These aren’t due until mid-May.
Help us to understand your RAC experience. Is your experience similar to this one? Have you had any experience with RACs at all? Do you have tips, ideas, questions, comments, or concerns? Submit your RAC stories and experiences to to jcarroll@hcpro.com and please indicate whether or not you’d like to remain anonymous.

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