Revenue Cycle

CMS publishes RAC improper payment vulnerabilities

Recovery Auditor Report, September 30, 2010

In an effort to propagate useful information on RAC high-dollar improper payment vulnerabilities, CMS released two additional special edition MLN Matters articles.

The articles, published September 23, offer education to providers regarding RAC demonstration-identified vulnerabilities in an effort to prevent the same problems from reoccurring. The three publications cover the following areas of risk:

Special edition article SE1027 specifically provides inpatient hospital education regarding 17 RAC demonstration-identified medical necessity vulnerabilities. According to CMS, the following inpatient hospital vulnerabilities may have occurred because the submitted medical documentation did not contain sufficient, accurate information to: support the diagnosis; justify the treatment/procedures; document the course of care; identify treatment/diagnostic test results; and promote continuity of care among healthcare providers:

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