Health Information Management

Health Information Management Articles by Topic: Recovery Audit Contractors

News: Denials suit dismissed; AHA says process improvements needed

  • CDI Strategies, Issue 2, January 22, 2015

    The battle over timely reviews for Medicare claims denials continues despite a federal...

AHA loses lawsuit over Recovery Auditor appeals

  • HIM-HIPAA Insider, Issue 2, January 12, 2015

    The District of Columbia federal district court dismissed a lawsuit December 18, 2014, filed by the...

Hospitals appealing nearly half of RAC denials

  • HIM-HIPAA Insider, Issue 49, December 22, 2014

    The American Hospital Association’s December 12 quarterly RACTrac survey revealed that nearly...

News: Developments related to patient status make murky waters muddier still

  • CDI Strategies, Issue 24, November 20, 2014

    The Office of the Inspector General (OIG) cited Yale-New Haven Hospital for errors which included...

News: Denials for Inpatient Surgical Procedure May Cross to Physician Claims

  • CDI Strategies, Issue 21, October 9, 2014

    If the hospital documentation, including history and physical and progress notes, doesn't support...

News: CMS offers deal to those willing to withdraw pending appeals

  • CDI Strategies, Issue 19, September 11, 2014

    In exchange for dropping appeals, CMS says it will provide partial payment of previously denied...

News: Recovery Auditors restart reviews; Senate weighs in on payment methodology

  • CDI Strategies, Issue 17, August 14, 2014

    Due to the continued delay in awarding new Recovery Auditor (RA) contracts, CMS made modifications...

News: Pilot programs aim to reduce appeals’ backlog

  • CDI Strategies, Issue 15, July 17, 2014

    Statistical sampling or alternative dispute resolution: These possible two solutions to the...

News: OIG Medicare Compliance Review provides new blueprint for CDI reviews

  • CDI Strategies, Issue 14, July 3, 2014

    If you haven’t seen the OIG report “Medicare Compliance Review of University of...

News: RACTrac report finds hospitals appeal 50% of denials

  • CDI Strategies, Issue 13, June 19, 2014

    Of all the Recovery Auditor denials, hospitals reported appealing about 50% with more than a 50...

News: AHA files civil suit related to Recovery Auditor backlog

  • CDI Strategies, Issue 12, June 5, 2014

    At the close of fiscal year 2013, nearly 5,000 claims denials remained pending review at the...

News: RACTrac survey: ’Hospitals appeal 49% of denials’

  • CDI Strategies, Issue 6, March 13, 2014

    The latest RACTrac survey from the American Hospital Association shows facilities 49% of denials...

CMS extends 2-midnight probe and educate period, and releases new guidance

  • HIM-HIPAA Insider, Issue 6, February 10, 2014

    CMS recently announced that it will extend the probe and educate period for review of admissions...

AHA urges CMS to address RA-appeals delay

  • HIM-HIPAA Insider, Issue 4, January 27, 2014

    In a recent letter, the American Hospital Association (AHA) urged CMS to work with the Office of...

News: OIG finds CMS, contractors could do more to establish EHR safeguards

  • CDI Strategies, Issue 2, January 16, 2014

      Contractors could use a little guidance from CMS to do a better job at reviewing medical...

News: CDI efforts in pre-payment reviews on the rise

  • CDI Strategies, Issue 2, January 16, 2014

    Of the nearly 450 respondents to a recent ACDIS website poll, 50% say they conduct pre-payment...

News: Three-month delay in patient status reviews related to new 'two-midnight' policy

  • CDI Strategies, Issue 23, November 7, 2013

    CMS will not conduct post-payment patient status reviews for admission dated October 1, 2013...

CMS guidance addresses reviews of inpatient admissions

  • HIM-HIPAA Insider, Issue 40, October 14, 2013

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News: Government focus on observation versus inpatient admission governance continues

  • CDI Strategies, Issue 19, September 12, 2013

    800x600 CMS issued new guidance last week aimed at clarifying the so-called...

News: OIG makes recommendations to improve Recovery Auditor oversight

  • CDI Strategies, Issue 19, September 12, 2013

    Although Recovery Auditors have identified more than a billion dollars in inappropriate payments...

News: Rebilling possible option for medical necessity denials

  • CDI Strategies, Issue 14, June 20, 2013

    Three out of four Recovery Auditors (RAs) list medical necessity of cardiovascular procedures as...

News: Rebilling opportunities

  • CDI Strategies, Issue 12, May 23, 2013

    Recovery Auditor (RA) denials and good news never seem to go hand in hand. However, CMS announced...

Recovery Auditors starting to review outpatient therapy services

  • APCs Insider, Issue 19, May 10, 2013

    Outpatient therapy services furnished between January 1 and December 31, 2013, are subject to a...

Recovery Auditors remain in the news

  • HIM-HIPAA Insider, Issue 13, April 15, 2013

    The Recovery Auditor (RA) program is alive and well judging by the number of news items popping up...

News: Recovery Auditors continue medical necessity reviews

  • CDI Strategies, Issue 8, April 11, 2013

    Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the...

Medicare Audit Improvement Act reintroduced, AHIMA shows support

  • HIM-HIPAA Insider, Issue 10, March 25, 2013

    The Medicare Audit Improvement Act, which aims to rectify problems identified in the Recovery...

HCPro’s 2013 Recovery Auditor Benchmarking Report

  • HIM-HIPAA Insider, Issue 9, March 18, 2013

    In 2012, Recovery Auditors continued to expand their reach and gain speed. How has your facility...

CMS issues proposed changes to Part B inpatient billing in hospitals

  • HIM-HIPAA Insider, Issue 9, March 18, 2013

    Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed...

News: Recovery Auditor activity intensifying

  • CDI Strategies, Issue 6, March 14, 2013

    Recovery auditor recoupments increased 14% since 2012, according to the 2013 Recovery Auditor...

News: Latest Recovery Auditor report sent to Congress

  • CDI Strategies, Issue 4, February 14, 2013

    Recovery Auditors (previously called Recovery Audit Contractors [RAC]) saved Medicare nearly $500...

News: Medical necessity battle continues; AHA says lawsuit requires urgent attention

  • CDI Strategies, Issue 27, December 20, 2012

    The fight over medical necessity continued last week as the American Hospital Association and its...

Tip: CDI growth depends on record review expansion

  • CDI Strategies, Issue 26, December 6, 2012

    By Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS In a recent CDI Talk conversation the...

News: Recovery Auditors on the hot seat: Suit filed against HHS

  • CDI Strategies, Issue 23, November 8, 2012

    On October 16, Representative Sam Graves (R-MO) introduced legislation to reform Recovery...

News: AHA supports bill to amend healthcare auditing programs

  • CDI Strategies, Issue 22, October 25, 2012

    A bill, introduced October 16, aims to curtail the proliferation of healthcare audits and medical...

News: CMS says more than $700 million in improper payments corrected

  • CDI Strategies, Issue 21, October 11, 2012

    Following the close of each fiscal year (FY) quarter, CMS releases statistics for the amount of...

News: Noridian issues reminder regarding selection of appropriate principal diagnosis

  • CDI Strategies, Issue 19, September 13, 2012

    The terms “admitting” diagnosis and “principal” diagnosis are not...

Consider self-audit before responding to request

  • JustCoding News: Inpatient, Issue 37, September 12, 2012

    Do you audit records before sending them to your Recovery Auditor? If not, your hospital may be one...

News: RAC activity on the rise, says AHA survey

  • CDI Strategies, Issue 18, August 30, 2012

    RAC denials rose by 24% over the previous quarter, according to the August 22 RACTrac survey...

CMS announces official start date for Recovery Auditor prepayment reviews

  • JustCoding News: Inpatient, Issue 33, August 15, 2012

    CMS officially announced the Recovery Auditor prepayment review demonstration in November 2011, but...

CMS announces official start date for Recovery Auditor prepayment reviews

  • HIM-HIPAA Insider, Issue 6, August 13, 2012

    CMS officially announced the Recovery Auditor prepayment review demonstration this past November...

News: Prepayment reviews demonstration project set to begin in August

  • CDI Strategies, Issue 16, August 2, 2012

    On August 27, CMS launches its Recovery Audit Prepayment Review demonstration project. Over the...

Tip: Start with emergency room documentation to help reduce claims denials

  • CDI Strategies, Issue 14, July 5, 2012

    By Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, C-CDI, CCDS Broaden the scope of your CDI...

News: Nearly half of RAC appeals overturned in favor of providers

  • CDI Strategies, Issue 13, June 21, 2012

    CMS recently posted two separate sets of data that provide nationwide statistics on its Recovery...

MAC prepayment reviews hit hospitals hard

  • HIM-HIPAA Insider, Issue 25, June 19, 2012

    MACs have already begun prepayment reviews at hospitals nationwide, and Medicare Recovery Auditors...

News: Identify potential Medicaid RAC target areas

  • CDI Strategies, Issue 11, May 24, 2012

    The Medicaid RAC program kicked off January 1. Although the program got off to a slow start...

OIG reports critique on CMS’ processes and programs

  • HIM-HIPAA Insider, Issue 21, May 22, 2012

    In recent months there has been a number of Office of Inspector General (OIG) reports released that...

News: NHIC Inc., finds one-day inpatient stays have high denial rates

  • CDI Strategies, Issue 10, May 10, 2012

    “This claim was denied after review and it was determined that the documentation did not...

Identify potential Medicaid RAC target areas

  • HIM-HIPAA Insider, Issue 15, April 10, 2012

    The Medicaid RAC program kicked off January 1, and experts say that although the program got off...

OIG examines CMS' CERT improper payment error rate estimations

  • HIM-HIPAA Insider, Issue 13, March 27, 2012

    On March 9, the OIG published the report, “Review of CERT Errors Overturned Through the...

Revenue Cycle Institute releases '2011 Recovery Audit Benchmarking Report'

  • HIM-HIPAA Insider, Issue 10, March 6, 2012

    The Revenue Cycle Institute has released a new white paper, “2011 Recovery Auditor...

News: Revenue Cycle Institute posts '2011 Recovery Auditor Benchmarking Report'

  • CDI Strategies, Issue 5, March 1, 2012

    More than 400 individuals responded to the “2011 Recovery Auditor Benchmarking Survey&rdquo...

News: Review Medicaid Integrity Contractors identify $282 million in potential overpayments

  • CDI Strategies, Issue 5, March 1, 2012

    Review Medicaid Integrity Contractors (MICs) completed 81% of their CMS assignments resulting in...

News: CMS releases first quarter report regarding Recovery Audit Program

  • CDI Strategies, Issue 4, February 16, 2012

    CMS’ Recovery Auditors (previously called Recovery Audit Contractors, now associated with the...

Permanent RAC program changes and new Medicaid program and pre-bill audit demonstration under way

  • JustCoding News: Inpatient, Issue 5, February 1, 2012

    Just when you thought you had your RAC processes in place, more changes appear on the horizon. CMS...

CMS releases details of recovery auditor prepayment review demonstration

  • HIM-HIPAA Insider, Issue 1, January 3, 2012

    On November 15, CMS announced that it will launch a number of demonstration programs that are set...

Coders play pivotal role in facilities’ efforts to curb improper payment allegations from auditors

  • JustCoding News: Inpatient, Issue 49, December 7, 2011

    Coders should not underestimate the vital role they play in their organization’s efforts to...

News: Demonstration program to expand RAC power

  • CDI Strategies, Issue 25, December 1, 2011

    Starting in January 2012, facilities could see pre-payment reviews from auditors involved in a new...

CMS announces new initiatives including RAC prepayment audits and Part B rebilling changes

  • HIM-HIPAA Insider, Issue 47, November 22, 2011

    As part of the ongoing effort to reduce improper payments in Medicare and Medicaid, CMS announced...

AHA to host November conference calls with CMS and RAC representatives

  • HIM-HIPAA Insider, Issue 43, October 25, 2011

    The American Hospital Association (AHA) will host four members-only conference calls—one for...

Revised RAC statement of work: Impact on providers

  • HIM-HIPAA Insider, Issue 41, October 11, 2011

    CMS released a revised RAC statement of work (SOW) September 12 that contains several revisions and...

Know how to identify, understand RAC compliance risks

  • HIM-HIPAA Insider, Issue 40, October 4, 2011

    It shouldn't come as a surprise that RACs use the Common Working File (CWF) to ensure that...

News: CMS releases Final Rule for Medicaid RACs

  • CDI Strategies, Issue 20, September 29, 2011

    On September 14, CMS released its Medicaid recovery audit contractor (RAC) final rule, which sets...

CMS releases Medicaid RACs final rule

  • HIM-HIPAA Insider, Issue 38, September 20, 2011

    In February, the Centers for Medicare and Medicaid Services (CMS) delayed its expected April 1...

CMS raises limits for RAC additional documentation for certain providers

  • HIM-HIPAA Insider, Issue 36, September 6, 2011

    As of August 22, recovery auditors can request up to 35 records per 45 days from non-supplier and...

News: Lackluster RAC returns could spur fourth quarter records rush

  • CDI Strategies, Issue 18, September 2, 2011

    To make up a gap in expected overpayment collections Recovery Audit Contractors may escalate audit...

News: TrailBlazer probe highlights documentation disparity

  • CDI Strategies, Issue 18, September 2, 2011

    Out of 88 claims for MS-DRG 246 (percutaneous cardiovascular procedure with drug-eluting stent with...

RAC demand letter responsibility shifted to MACs

  • HIM-HIPAA Insider, Issue 34, August 23, 2011

    RACs previously had been responsible for issuing demand letters to providers, but a July 29...

Decisions, decisions, decisions: Appealing denials, addressing interest, and making a case

  • HIM-HIPAA Insider, Issue 34, August 23, 2011

    Denied claims got you down? An upper-level appeal may be the answer.

News: MACs to take over demand letter submission from RACs

  • CDI Strategies, Issue 17, August 18, 2011

    In January facilities should expect to receive Recovery Audit Contractors (RAC) demand letters not...

Tip: Making sense of myocardial infarction sequencing rules

  • CDI Strategies, Issue 17, August 18, 2011

    By Linda Renee Brown, RN, CCRN, CCDS, MA One of the most confusing diagnoses to code and sequence...

News: RACs target ventilator support

  • CDI Strategies, Issue 15, July 21, 2011

    RACs can easily data-mine for noncompliance related to coding for ventilator support, says Glenn...

Tip: Revenue Cycle Institute offers helpful tools at no cost

  • CDI Strategies, Issue 15, July 21, 2011

    Each month the Revenue Cycle Institute publishes a free sample tool or form for readers. This...

Coming soon in MRB!

  • HIM-HIPAA Insider, Issue 29, July 19, 2011

    In the August issue of MRB, you’ll find articles on the following articles and more.

News: Special MLN Matters article discusses RAC DRG vulnerabilities

  • CDI Strategies, Issue 14, July 7, 2011

    Inpatient hospital claims submitted to Medicare contain “a significant amount” of...

Special editions MLN articles highlight inpatient coding vulnerabilities and admit date issues

  • HIM-HIPAA Insider, Issue 27, July 5, 2011

    CMS released two special edition MLN articles last week. One article, SE1121, highlights some of...

Use PEPPER to enhance your RAC readiness

  • HIM-HIPAA Insider, Issue 25, June 21, 2011

    Not sure where to focus your RAC preparations these days? Look no further than the Program for...

Coming soon in MRB!

  • HIM-HIPAA Insider, Issue 25, June 21, 2011

    In the July issue of MRB, you’ll find articles on the following articles and more!

Q&A: RAC, medical necessity, and the role of CDI

  • CDI Strategies, Issue 12, June 9, 2011

    Q: With all the auditing going on I would like to find out how effects CDI programs in other...

News: AHA releases first quarter 2011 RACTrac report

  • CDI Strategies, Issue 11, May 26, 2011

    Recovery Audit Contractors (RAC) reported doubled its recovery amounts since last...

Coming soon in MRB!

  • HIM-HIPAA Insider, Issue 20, May 17, 2011

    In the June issue of MRB, you’ll find articles on the following articles and more!

Membership update: White Paper regarding CDI role in RAC preparation posted

  • CDI Strategies, Issue 10, May 12, 2011

    What kind of return can your CDI program guarantee in terms of RAC preparedness? That’s the...

News: CMS issues latest quarterly provider compliance newsletter

  • CDI Strategies, Issue 10, May 12, 2011

    Improper coding of MS-DRG 813 (coagulation disorders), reporting an extensive operating room...

CMS issues latest quarterly provider compliance newsletter

  • HIM-HIPAA Insider, Issue 19, May 10, 2011

    CMS and the Medicare Learning Network (MLN) released the third Medicare Quarterly Provider...

Inpatient-only procedures: Ensure compliance, avoid RAC recoupments

  • HIM-HIPAA Insider, Issue 19, May 10, 2011

    Inpatient coders may lack familiarity with the ¬inpatient-only procedure list because CMS...

CMS identifies total improper payment figures, top RAC issue per region

  • HIM-HIPAA Insider, Issue 18, May 3, 2011

    CMS released a short but useful Recovery Audit Contractor (RAC) update on its website last week...

News: AMA submits comments to CMS regarding federal regulatory burdens

  • CDI Strategies, Issue 9, April 28, 2011

    In response to President Barack Obama’s January 18 executive order aimed at reducing federal...

Coming soon in MRB

  • HIM-HIPAA Insider, Issue 16, April 19, 2011

    In the May issue of MRB, you’ll find articles on the following topics and more!

RACs using 'semi-automated' claims review

  • HIM-HIPAA Insider, Issue 15, April 12, 2011

    Providers familiar with automated claims reviews and complex claims reviews by the recovery RACs...

CMS raises documentation request limits for certain hospitals

  • HIM-HIPAA Insider, Issue 11, March 15, 2011

    CMS recently increased the number of medical records that recovery audit contractors (RAC) can...

CMS updates RAC underpayment instructions

  • HIM-HIPAA Insider, Issue 11, March 15, 2011

    CMS updated the instructions related to processing underpayments indentified by RACs in Transmittal...

CMS delays Medicaid RAC implementation, issues RAC map

  • HIM-HIPAA Insider, Issue 10, March 8, 2011

    CMS has officially delayed the proposed April 1 deadline for states to implement their Medicaid RAC...

AHA weighs in on Part C RACs

  • HIM-HIPAA Insider, Issue 10, March 8, 2011

    On February 23, the American Hospital Association sent a letter to CMS regarding the expansion of...

News: California facilities struggle with allegations of inappropriately billing for kwashiorkor

  • CDI Strategies, Issue 5, March 3, 2011

    If the data is true, the population of a couple of concentrated areas in California suffer from...

Q&A: Re-billing an account after a late query response

  • CDI Strategies, Issue 5, March 3, 2011

    Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to...

CMS announces electronic data submission tool for providers

  • HIM-HIPAA Insider, Issue 9, March 1, 2011

    Currently, providers respond to documentation requests from review contractors such RACs and...

CMS forms EHR listserv, posts RAC ADR limits for physicians

  • HIM-HIPAA Insider, Issue 8, February 22, 2011

    On February 10, CMS announced a new listserv for the Medicare and Medicaid EHR incentive programs...

Tip: Documentation key to ensuring inpatient medical necessity

  • CDI Strategies, Issue 4, February 17, 2011

    The RACs have ramped up medical necessity reviews. Determining the medical necessity of an...

News: RACs target respiratory system diagnosis with ventilator support

  • CDI Strategies, Issue 4, February 17, 2011

    A recent special edition MedLearn Matters article SE1028 outlines four risk areas targeted by the...

Contractors to deny claim line items with -GZ modifier

  • HIM-HIPAA Insider, Issue 7, February 15, 2011

    In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs...

Know when to report secondary diagnoses

  • HIM-HIPAA Insider, Issue 7, February 15, 2011

    A patient’s medical record could include a laundry list of diagnoses, but not all of these...

Coming soon in MRB

  • HIM-HIPAA Insider, Issue 7, February 15, 2011

    In the March issue of MRB, you’ll find articles on the following topics and more!

CMS releases RAC FAQ regarding 60-day determination requirement

  • HIM-HIPAA Insider, Issue 5, February 1, 2011

    On January 13, CMS released a new recovery audit contractor (RAC) FAQ regarding the requirement for...

CMS asks for Part C and D RAC suggestions

  • HIM-HIPAA Insider, Issue 3, January 18, 2011

    CMS published a notice in the Federal Register December 27 asking for comments on the RAC program...

Ensure thorough inpatient rehabilitation documentation

  • HIM-HIPAA Insider, Issue 3, January 18, 2011

    Now that medical record audits are the rule rather than the exception, inpatient rehabilitation...

Know which coding issues to include in your facility's 2011 audit plan

  • HIM-HIPAA Insider, Issue 2, January 11, 2011

    With an ever-growing list of RAC-targeted MS-DRGs and a host of coding compliance traps that...

Q&A: Ready for Medicaid RAC?

  • CDI Strategies, Issue 1, January 6, 2011

    Q: How should providers prepare for Medicaid RACs?  

News: 2010 RAC Preparedness Benchmarking Report released

  • CDI Strategies, Issue 26, December 23, 2010

    The RAC program was fully under way in 2010, and providers continue to struggle with it as the year...

CMS now requiring ABN review as part of MAC, CERT, RAC, and ZPIC documentation requests

  • HIM-HIPAA Insider, Issue 50, December 21, 2010

    On December 10 CMS released Transmittal 361, Change Request 6988 that MACs, CERT, RACs, and ZPICs...

Make sense of Medicaid RACs

  • HIM-HIPAA Insider, Issue 50, December 21, 2010

    Signs are pointing to the fact that Medicaid RACs might not be the stuff of unicorns or Santa...

Take time to understand acute kidney injury versus acute renal failure

  • HIM-HIPAA Insider, Issue 49, December 14, 2010

    The language physicians use to create a patient’s clinical picture doesn’t always...

News: CMS publishes 2011 RAC ADR limits for providers

  • CDI Strategies, Issue 24, November 24, 2010

    CMS has modified the additional documentation request (ADR) limits (i.e., medical record request...

CMS publishes 2011 RAC ADR limits for providers

  • HIM-HIPAA Insider, Issue 46, November 23, 2010

    CMS has modified the additional documentation request (ADR) limits (i.e., medical record request...

Involve coders in your RAC defense strategy

  • HIM-HIPAA Insider, Issue 46, November 23, 2010

    Now that RAC medical necessity audits are well under way, the focus has shifted from anticipatory...

CMS takes first step toward Medicaid RAC implementation

  • HIM-HIPAA Insider, Issue 45, November 16, 2010

    CMS released the long-anticipated proposed rule for Medicaid RACs November 5, setting the stage for...

Medical necessity audits: Involve coders in your RAC defense strategy

  • HIM-HIPAA Insider, Issue 45, November 16, 2010

    Hospitals have waited with bated breath for RAC medical necessity audits to begin. Now that the...

CMS issues new guidance for Medicaid integrity contractors

  • HIM-HIPAA Insider, Issue 43, November 2, 2010

    On October 25, AHA News Now published information on a new CMS policy that prohibits Medicaid...

Briefings on Coding Compliance Strategies, November 2010

  • Briefings on Coding Compliance Strategies, Issue 11, November 1, 2010

    Learn about medical necessity audits, linking signs and symptoms with definitive conditions...

Avoid encoder overreliance

  • HIM-HIPAA Insider, Issue 42, October 26, 2010

    As hospitals move toward ICD-10, an overreliance on encoders could become more of a problem as...

CMS publishes RAC improper payment vulnerabilities

  • HIM-HIPAA Insider, Issue 39, October 5, 2010

    In an effort to propagate useful information on RAC high-dollar improper payment vulnerabilities...

Address insufficient documentation to prepare for RACs

  • HIM-HIPAA Insider, Issue 39, October 5, 2010

    As providers navigate their way through complex reviews and the newly approved medical necessity...

Briefings on Coding Compliance Strategies, October 2010

  • Briefings on Coding Compliance Strategies, Issue 10, October 1, 2010

    Learn about new and revised ICD-9-CM codes, identifying high-risk vulnerabilities in preparation...

News: Inpatient admissions decision fuels RAC uncertainty

  • CDI Strategies, Issue 19, September 16, 2010

    Recent approval of a RAC issue for inpatient hospital claims review has initiated uncertainty...

Tips for RAC appeal success

  • HIM-HIPAA Insider, Issue 35, September 7, 2010

    According to a July HCPro survey of approximately 500 healthcare providers, 56% have already...

News: Review coding, documentation guidelines for latest RAC target-neoplasms

  • CDI Strategies, Issue 18, September 2, 2010

    Confusing coding guidelines and insufficient documentation have made neoplasms a target area as...

Tip: Audit records for signature documentation

  • CDI Strategies, Issue 18, September 2, 2010

    CMS requires that orders for healthcare services be authenticated using either a handwritten or...

Take advantage of nine tips for RAC appeal success

  • HIM-HIPAA Insider, Issue 34, August 31, 2010

    According to a July HCPro survey of approximately 500 healthcare providers, 56% have already...

Coming soon in Medical Records Briefing

  • HIM-HIPAA Insider, Issue 13, August 24, 2010

    In the September issue of MRB, you’ll find articles on the following topics and more!

News: CMS approves first of RAC medical necessity reviews

  • CDI Strategies, Issue 17, August 19, 2010

    The Centers for Medicare & Medicaid Services (CMS) recently approved the first “medical...

CMS approves 18 medical necessity issues for RAC review

  • HIM-HIPAA Insider, Issue 32, August 17, 2010

    The long wait for medical necessity RAC reviews will soon be over. CMS recently approved the first...

Tip: Query for type, underlying causes, and/or stage of heart failure and CKD

  • CDI Strategies, Issue 16, August 5, 2010

    It’s not enough to know whether heart failure is systolic or diastolic. Congestive heart...

Review of neoplasm coding guidelines good strategy when preparing for RAC audits

  • Briefings on Coding Compliance Strategies, Issue 8, August 1, 2010

    It shouldn’t come as a surprise that HealthDataInsights—the RAC for Region D—is...

Don’t fall into these avoidable V code traps

  • Briefings on Coding Compliance Strategies, Issue 8, August 1, 2010

    V codes play an important role in painting an accurate picture of an admission and facilitating...

Briefings on Coding Compliance Strategies, August 2010

  • Briefings on Coding Compliance Strategies, Issue 8, August 1, 2010

    Learn about avoidable V code traps, why you shouldn't bypass coding rules for more money, why...

Tip: Reduce RAC denials with targeted auditing

  • HIM-HIPAA Insider, Issue 29, July 27, 2010

    Providers can make a great impact in terms of reducing RAC denials at their facilities with...

Q&A: RAC MLN Matters article

  • HIM-HIPAA Insider, Issue 28, July 20, 2010

    Q: What should providers know about CMS’ new RAC MLN Matters article?

Prevent RAC DRG validation and complex coding denials

  • HIM-HIPAA Insider, Issue 26, July 6, 2010

    Medically unnecessary services and incorrectly coded items had the highest amounts of RAC...

Prepare for RAC audits by taking a closer look at mechanical ventilation

  • Briefings on Coding Compliance Strategies, Issue 7, July 1, 2010

    Inpatient admissions requiring mechanical ventilation tend to be high-dollar cases, which is...

Briefings on Coding Compliance Strategies, July 2010

  • Briefings on Coding Compliance Strategies, Issue 7, July 1, 2010

    Learn whether coders should delay sending a claim because of a missing discharge summary.

Coming soon in Medical Records Briefing

  • HIM-HIPAA Insider, Issue 24, June 22, 2010

    In the July issue of MRB, you’ll find the following articles and more!

Don’t let improper discharge disposition codes fly under the radar at your facility

  • Briefings on Coding Compliance Strategies, Issue 6, June 1, 2010

    You may think the discharge disposition codes you  assign are correct, but discharge plans...

Briefings on Coding Compliance Strategies, June 2010

  • Briefings on Coding Compliance Strategies, Issue 6, June 1, 2010

    Learn about the three-day payment rule, FY 2011 IPPS Proposed Rule, discharge disposition codes...

CMS says medical necessity, physician complex audits on their way

  • HIM-HIPAA Insider, Issue 21, June 1, 2010

    On the May 12 RAC 101 call for physicians, a caller asked CMS specific information about when...

CMS addresses medical necessity reviews, RAC expansion in RAC 101 call

  • HIM-HIPAA Insider, Issue 19, May 18, 2010

    CMS representatives addressed two developing recovery audit contractor (RAC) areas during the May 5...

Help ensure compliance when reporting cirrhosis and alcoholic hepatitis with an MCC

  • HIM-HIPAA Insider, Issue 19, May 18, 2010

    MS-DRG 432 (cirrhosis and alcoholic hepatitis with MCC) is one of many MS-DRGs slated for RAC...

News: CMS offers partial answer to RAC query submission questions

  • CDI Strategies, Issue 10, May 13, 2010

    CMS has been holding a number of open forum calls regarding its Recovery Audit Contractor (RAC...

Take advantage of free RAC tools available from the Revenue Cycle Institute

  • HIM-HIPAA Insider, Issue 17, May 4, 2010

    Did you know that the HCPro Revenue Cycle Institute is a great source for free tools for those in...

Prepare for RAC audits by exercising caution with septicemia codes

  • HIM-HIPAA Insider, Issue 16, April 27, 2010

    Overcoding and coding based on insufficient documentation may be one reason why RACs are auditing...

CMS issues new RAC FAQ, video

  • HIM-HIPAA Insider, Issue 15, April 20, 2010

    On April 13, CMS released the following new RAC FAQ: Can the RAC do a medical necessity review on a...

CMS announces upcoming RAC calls

  • HIM-HIPAA Insider, Issue 14, April 13, 2010

    On April 6 CMS announced a series of upcoming RAC calls for different provider types.

Coding postop or post-traumatic infections with OR procedures

  • HIM-HIPAA Insider, Issue 14, April 13, 2010

    RACs already are validating countless MS-DRGs in hospitals nationwide, and the number of eligible...

Audit for signatures: New transmittal clarifies assessment requirements

  • HIM-HIPAA Insider, Issue 13, April 6, 2010

    In the current regulatory environment many contractors review claims and medical documentation...

HIM central to surviving RACs as auditing activity is on the rise

  • HIM Briefings, Issue 4, April 1, 2010

    Recovery audit contractor (RAC) activity is picking up, but many healthcare providers are still...

Medical Records Briefing, April 2010

  • HIM Briefings, Issue 4, April 1, 2010

    This month's issue includes an article on HIMs role in surviving recovery audit contractor (RAC...

Brush up on sequencing as RAC complex audits begin

  • HIM Briefings, Issue 4, April 1, 2010

    As recovery audit contractors (RAC) begin to roll out complex reviews and request medical record...

Changes coming for HIM in wake of healthcare reform bill

  • HIM-HIPAA Insider, Issue 12, March 30, 2010

    Now that the Senate and House have put the finishing touches on the newly signed...

White House memorandum mandates additional recovery audits

  • HIM-HIPAA Insider, Issue 10, March 16, 2010

    A March 10 White House memorandum on finding and recapturing improper payments has mandated...

Coming soon in Medical Records Briefing

  • HIM-HIPAA Insider, Issue 10, March 16, 2010

    In the April issue of MRB, you’ll find the following articles, and more! EHR beat...

News: Take RAC lessons to heart

  • CDI Strategies, Issue 5, March 4, 2010

    Those who lived through the RAC demonstration project learned valuable lessons along the way...

Audit wound debridement MS-DRGs before your RAC does

  • Briefings on Coding Compliance Strategies, Issue 3, March 1, 2010

    Coders don't need a RAC audit to tell them that reporting inpatient wound care is particularly...

Use PEPPER reports to stay on top of common coding errors

  • HIM-HIPAA Insider, Issue 5, February 9, 2010

    HIM directors can evaluate their hospital’s potential risk for overcoding and unnecessary...

Brush up on sequencing as RAC complex reviews get under way

  • HIM-HIPAA Insider, Issue 5, February 9, 2010

    As RACs begin to roll out complex reviews and request medical record documentation, compliant...

Survey shows RAC activity is on the rise

  • HIM-HIPAA Insider, Issue 5, February 2, 2010

    Nearly 20% of healthcare providers have already received Recovery Audit Contractor (RAC...

RAC posts dozens of new issues for under- and overpayment DRG-validation complex review

  • HIM-HIPAA Insider, Issue 3, January 19, 2010

    In recent weeks, HealthDataInsights (HDI) has added dozens of new issues to its CMS-approved list...

AHA offers comments on Congress healthcare reform bills

  • HIM-HIPAA Insider, Issue 2, January 12, 2010

    The American Hospital Association (AHA) offered comments and suggestions on the Senate and House...

HCPro releases RAC preparedness benchmarking survey results

  • HIM Briefings, Issue 1, January 1, 2010

    HCPro’s “RAC Preparedness Benchmarking Report” shows that HIM directors play a...

Medical Records Briefing, January 2010

  • HIM Briefings, Issue 1, January 1, 2010

    This month’s 16-page expanded issue includes our four-page quarterly insert that focuses on...

RACs continue to post new CMS-approved audit issues

  • HIM-HIPAA Insider, Issue 52, December 29, 2009

    DCS Healthcare, Connolly Healthcare, and HealthDataInsights (HDI), the RACs for regions A, C, and...

Identify top MIC targets

  • HIM-HIPAA Insider, Issue 50, December 15, 2009

    What will Medicaid Integrity Contractor auditors be looking for? Here are some possible issues...

HCPro releases RAC preparedness benchmarking survey results

  • HIM-HIPAA Insider, Issue 50, December 15, 2009

    In 2009, HCPro’s Revenue Cycle Institute conducted an in-depth study on recovery audit...

RAC begins complex DRG validation audits: Medical record documentation requests imminent

  • HIM-HIPAA Insider, Issue 49, December 8, 2009

    Connolly Healthcare has announced the first issues approved for complex RAC review, so providers in...

Survey shows RAC preparations well under way despite budget issues

  • HIM-HIPAA Insider, Issue 48, December 1, 2009

    Budgets are tight, but many healthcare providers appear to be aware that setting aside resources to...

CMS to resume releasing PEPPER data in 2010

  • HIM-HIPAA Insider, Issue 47, November 24, 2009

    CMS has contracted with the TMF Health Quality Institute to again release Program for Evaluating...

Providers report first RAC denials in Florida, South Carolina

  • HIM-HIPAA Insider, Issue 46, November 17, 2009

    Healthcare providers in several states received their first RAC denials. Connolly Healthcare, the...

Ask the right questions regarding RAC records requests

  • HIM-HIPAA Insider, Issue 40, October 6, 2009

    Inpatient hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and hospice...

Last RAC announces first issue--DCS posts approved issues for Region A

  • HIM-HIPAA Insider, Issue 38, September 22, 2009

    DCS Healthcare has released its first CMS-approved issues for audits in Region A. The three...

Illinois hospital ensures one-day stay compliance to avoid RACs

  • HIM Briefings, Issue 9, September 1, 2009

    The final phase of the national Recovery Audit Contractor (RAC) rollout began last month, and...

Medical Records Briefing, September 2009

  • HIM Briefings, Issue 9, September 1, 2009

    This month’s issue covers a wide variety of topics of interest to HIM directors. Our cover...

Briefings on Coding Compliance Strategies September 2009

  • Briefings on Coding Compliance Strategies, Issue 9, September 1, 2009

    In this issue, we dissect the final 2010 IPPS rule, plus discuss the three new NCDs for never...

NCDs clarify how to identify and report never events

  • Briefings on Coding Compliance Strategies, Issue 9, September 1, 2009

    Our experts help interpret CMS’ national coverage determinations, which include...

Voluntary refunds don't protect against RACs

  • HIM-HIPAA Insider, Issue 35, September 1, 2009

    For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal...

CGI posts first approved issues for RAC review in region B

  • HIM-HIPAA Insider, Issue 35, September 1, 2009

    Region B, get ready. RACs may begin auditing at any time in several Region B states. CGI Federal...

Connolly posts issues for review in Florida: Issues differ between region C states

  • HIM-HIPAA Insider, Issue 34, August 25, 2009

    Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida, including...

HealthDataInsights launches new RAC Web site, posts issues eligible for audits

  • HIM-HIPAA Insider, Issue 33, August 18, 2009

    HealthDataInsights, Inc. launched its new RAC Web site, and posted the first set of issues eligible...

RAC audits to begin in Region C

  • HIM-HIPAA Insider, Issue 32, August 11, 2009

    Heads up, healthcare providers: Connolly Healthcare, the RAC for Region C, has posted the first set...

Know CMS RAC audit phase-in strategy

  • HIM-HIPAA Insider, Issue 27, July 7, 2009

    CMS released further information June 24 on its RAC Web site letting healthcare providers know when...

Is your hospital owed money for PACTs?

  • Briefings on Coding Compliance Strategies, Issue 7, July 1, 2009

    The job of the recovery audit contractors (RAC) is twofold: Identify overpayments to recoup excess...

The quick list: Eight recovery audit contractor refreshers

  • Briefings on Coding Compliance Strategies, Issue 7, July 1, 2009

    In August, the recovery audit contractor (RAC) program will extend to all states nationwide. In...

Briefings on Coding Compliance Strategies, July 2009

  • Briefings on Coding Compliance Strategies, Issue 7, July 1, 2009

    The transition to ICD-10 and preparing for recovery audit contractors are two big issues for...

Management matters: Eight essential questions every HIM director should ask about RAC record requests

  • HIM Briefings, Issue 7, July 1, 2009

    How many record requests can HIM directors expect to receive now that the permanent Recovery Audit...

Medical Records Briefing, July 2009

  • HIM Briefings, Issue 7, July 1, 2009

    This month’s expanded issue includes our 4-page quarterly insert about electronic health...

Eight essential questions every HIM director should ask about RAC record requests

  • HIM-HIPAA Insider, Issue 25, June 23, 2009

    How many record requests can HIM directors expect to receive now that the permanent Recovery Audit...

CMS postpones RAC complex reviews of medical necessity until 2010

  • HIM-HIPAA Insider, Issue 23, June 9, 2009

    CMS anticipates Recovery Audit Contractor (RAC) automated reviews will begin in late June and July...

Pay attention to new RAC FAQs

  • HIM-HIPAA Insider, Issue 22, June 2, 2009

    CMS released four new and updated RAC FAQ on May 19. The FAQ range from the broad ("Why is CMS...

CMS discusses RACs, ICD-10, and wage indexes

  • Briefings on Coding Compliance Strategies, Issue 6, June 1, 2009

    During its most recent Open Door Forum, held May 6, CMS discussed several inpatient-related topics...

CMS FAQ addresses RAC medical record requests

  • HIM-HIPAA Insider, Issue 21, May 26, 2009

    CMS released a RAC FAQ April 29 with important news that may have previously flown under the radar...

Understand new AHA RACTrac initiative

  • HIM-HIPAA Insider, Issue 19, May 12, 2009

    Q: I’ve heard that the American Hospital Association (AHA) will be tracking the effects of...

Understand inpatient wound care coding for RAC audits

  • HIM-HIPAA Insider, Issue 19, May 12, 2009

    During the three-year RAC demonstration project, payment for several inpatient debridement...

Understand inpatient wound care coding for RAC audits

  • Briefings on Coding Compliance Strategies, Issue 5, May 1, 2009

    Two ICD-9 codes denote debridement in relation to wound care: 86.22, excisional debridement of...

Briefings on Coding Compliance Strategies, May 2009

  • Briefings on Coding Compliance Strategies, Issue 5, May 1, 2009

    Across the country, hospitals are focusing more time and energy on improving quality of care, not...

APC Answer Letter May 2009

  • APC Answer Letter, Issue 5, May 1, 2009

    Inside: Blood procedures: Code correctly when the only service is specimen collection via...

CMS pilot program targets hospitals readmissions

  • HIM-HIPAA Insider, Issue 17, April 28, 2009

    On April 13, CMS announced a pilot project to reduce rates of hospital readmissions. The Care...

Create a database to manage and track RAC requests

  • HIM-HIPAA Insider, Issue 15, April 14, 2009

    A comprehensive database is the critical to managing recovery audit contractor (RAC) requests. The...

Listen in on upcoming RAC Open Door Forum calls

  • HIM-HIPAA Insider, Issue 14, April 7, 2009

    CMS will be holding two Special Open Door Forums on Recovery Audit Contractors (RAC) for Part A and...

CMS discusses RACs, MACs, and AHRQ measures

  • Briefings on Coding Compliance Strategies, Issue 4, April 1, 2009

    During its most recent Open Door Forum (ODF) on February 25, CMS discussed several...

Briefings on Coding Compliance Strategies, April 2009

  • Briefings on Coding Compliance Strategies, Issue 4, April 1, 2009

    As part of a recent focus on patient safety, CMS has ramped up its efforts to curb...

Briefings on APCs, April 2009

  • Briefings on APCs, Issue 4, April 1, 2009

    Inside: Watch for changing physician supervision requirements Few changes to date in HCPCS...

Tip of the week

  • APCs Insider, Issue 13, March 27, 2009

    Recovery audit contractors (RAC) cannot randomly select or target a claim "solely because it...

CMS announces schedule to begin provider outreach about RACs

  • HIM-HIPAA Insider, Issue 12, March 24, 2009

    On March 19, CMS posted a schedule that includes various provider outreach sessions for regions A...

RAC outreach sessions

  • APCs Insider, Issue 9, February 27, 2009

    With RAC officially underway, hospitals and providers should begin fine-tuning their RAC...

CMS settles RAC contract negotiations and prepares to begin expansion March 1

  • HIM-HIPAA Insider, Issue 7, February 17, 2009

    The Medicare Recovery Audit Contractor (RAC) program is moving full speed ahead now that CMS has...

RACs are back on track

  • APCs Insider, Issue 7, February 13, 2009

    CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests...

RAC appeals on the rise according to new CMS statistics

  • HIM-HIPAA Insider, Issue 2, January 13, 2009

    CMS revised its July 2008 RAC appeal update to include appeals statistics through August 31, 2008.

RAC focus areas

  • APCs Insider, Issue 1, January 2, 2009

    The RAC demonstration project revealed several target areas. HIM directors should focus on these...

Form a RAC response team before it's too late

  • HIM Briefings, Issue 1, January 1, 2009

    These days, the words “recovery audit contractor” (RAC) are on every HIM...

Target these RAC focus areas

  • HIM-HIPAA Insider, Issue 50, December 23, 2008

    Kathy M. Johnson, RHIA, director of coding services at Care Communications in Chicago, says the RAC...

CMS offers RAC details despite temporary program halt

  • Briefings on Coding Compliance Strategies, Issue 12, December 1, 2008

    Officials answer questions during special ODF By now, one point remains clear: CMS has halted the...

CMS discusses RAC expansion, ICD-10, and never events

  • Briefings on Coding Compliance Strategies, Issue 12, December 1, 2008

    CMS discusses RAC expansion, ICD-10, and never events CMS hosted a Hospital & Hospital Quality...

Understand RAC medical record request limitations

  • HIM-HIPAA Insider, Issue 45, November 18, 2008

    Regardless of the fact that CMS announced November 3 that it would delay all recovery audit...

News: RAC delay likely temporary

  • CDI Strategies, Issue 23, November 13, 2008

    CMS has delayed the Medicare Recovery Audit Contractor (RAC) permanent program and put a moratorium...

CMS delays RAC permanent program

  • HIM-HIPAA Insider, Issue 44, November 11, 2008

    CMS announced on November 3 that it has delayed the Medicare Recovery Audit Contractor (RAC...

One-day stays

  • Briefings on Coding Compliance Strategies, Issue 11, November 1, 2008

    Forty percent of Medicare admission denials relate to improper one-day stays. If this statistic...

News: CMS announces permanent RAC contractors

  • CDI Strategies, Issue 21, October 16, 2008

    CMS announced the new Medicare Recovery Audit Contractors (RACs) for its permanent nationwide...

RAC report casts spotlight on wrong patient settings

  • APCs Insider, Issue 18, May 2, 2008

    Hospitals nationwide are taking notice of the Recovery Audit Contractor (RAC) program and the 2007...