Revenue Cycle

CMS approves 18 medical necessity issues for RAC review

Recovery Auditor Report, August 19, 2010

Finally, the wait is over. The first set of approved medical necessity issues were posted August 12 by CGI, the Region B RAC, following an AHA announcement earlier this week that the initial review audits were approved by CMS, and would be released within two weeks.

Medical necessity issues have been a hot topic for months. In a May CMS Open Door Forum call, a CMS representative suggested that medical necessity issues had been submitted to CMS, but CMS had not yet approved them — yet anticipated doing so in the “near future.” However, the delay comes as no surprise, according to Michael Taylor, MD, senior medical director of government and regulatory affairs at Executive Health Resources in Newtown Square, PA.

“This is very consistent with the pattern we’ve seen with RACs since the roll out of the permanent program,” he says. “CMS has been very deliberate in vetting the subjects that RACs are allowed to review.”

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