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Recovery Auditor Report

The Recovery Auditor Report is a free biweekly e-newsletter of useful tips and strategies to get you prepared for the arrival of Medicare's Recovery Audit Contractors (RACs).

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Recovery Auditor Report

Issue 25, December 24, 2009

• Editor's note: Happy holidays from HCPro, Inc.

  Dear readers, On behalf of HCPro, Inc., and the members of the RAC Report Advisory Board, I...

• Providers receive first RAC medical record documentation requests

  Requests for medical records are already arriving in hospital mailboxes following the approval of...

• DCS Healthcare, HDI post new RAC issues

  DCS Healthcare has added a new RAC issue to its CMS-approved list this week for providers in the...

• Q&A: Condition code 44 and physician review

  Q: I had a question about the requirement for hospital use of condition code 44. It is my...

• Medical records compilation: Handle RAC documentation requests

  The medical record compilation process begins when the RAC makes a request, which must promptly...

• Preparing for RACs: Steps to consider

  Taking certain preventive measures can go a long way toward preparing your facility for RAC audits...

Issue 24, November 25, 2009

• Providers report first RAC denials in Florida, South Carolina

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

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

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

• Revenue Cycle Institute releases free RAC Preparedness Benchmarking Report

  Budgets are tight, but it seems that many healthcare providers are aware that setting aside...

• CMS changes RAC medical record request limits for DRG validation audits

  CMS has published new documentation request limits for RAC DRG validation audits in 2010. CMS...

• Region D RAC approved to audit modifiers -TC and -26, adds DME issue

  HealthDataInsights (HDI) has been approved by CMS to audit for inappropriate billing related to the...

• Senate health reform bill expands RAC program to Medicaid, Medicare Parts C and D

  Hold on to your stethoscopes, the Senate Healthcare Reform Bill is expanding the RAC program...

• Understand the issues: RACs and IV hydration audits

  Some of the issues CMS has already approved for review under the RAC permanent program are...

• HealthDataInsights posts new RAC issue for Part B claims

  HealthDataInsights (HDI) has added a new RAC issues to its CMS-approved list earlier this month for...

• CMS releases five new, updated RAC FAQ

  CMS released several new and updated FAQ on its Web site November 17.

• Region B RAC adds DME claim issue, expands existing issues to new states

  CGI, the RAC for Region B, has added a new audit issue for DME claims, and updated the previously...

• CMS to begin releasing PEPPER data again in 2010

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

• Survival in a new era of enforcement a tall order for hospitals

  The struggling economy has left many hospitals with thin wallets, and government auditors are...

• Have you been received a RAC medical record request?

  If you’ve received a RAC medical record request, we want to hear from you. The first two...

• Revenue Cycle Institute posts free monthly tool

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

Issue 23, November 12, 2009

• HealthDataInsights posts several new RAC DME claim issues

  HealthDataInsights (HDI) has added multiple new RAC issues to their CMS-approved list in late...

• Could RAC mass adjustment changes mean increase in automatic audits?

  Providers who believe their RAC denials will be limited to 200 every 45 days (corresponding with...

• RAC vs. CERT audits: Do you know the difference?

  The Comprehensive Error Rate Testing (CERT) Hospital Payment Monitoring Program is one of the ways...

• Have you been audited by a RAC?

  If you’ve been audited by a RAC–for example, perhaps you’ve received a demand...

• Revenue Cycle Institute posts free coding tool

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

Issue 22, October 29, 2009

• Region B and D RACs post new issues, all states now approved for audits

  CGI, the RAC for Region B, has posted three new issues for review in Illinois, Indiana, Kentucky...

• CMS releases new FAQ on N432

  On October 15 CMS released an FAQ on the appearance of code N432 on remittance advice.

• Sneak preview: Comparing appeal rates for RACs vs. claims processing contractors

  The high number of claims determinations appealed was a measure of dissatisfaction with the RAC...

• Audits underway, but hospital continues to refine in preparation for RACs

  St. Joseph Medical Center in Houston has been preparing for RACs for months now, says Cucharras...

• Escalating Medicare and Medicaid auditing on the horizon

  There’s no question that audit activity is escalating and the healthcare provider community...

Issue 21, October 15, 2009

• AHA RAC Program Update answers provider questions

  As of September 18, all four RACs were conducting automated audits, according to an October 6...

• Two new issues for RAC Region D

  HealthDataInsights (HDI) has announced two new issues for region D.

• CMS plans appeals town hall meeting

  CMS planned a town hall meeting for November 5 from 1-3:30 p.m. Eastern Time to discuss appeals of...

• Five last-minute tips to prepare for RACs

  RACs have begun auditing at this point, and providers in some states may have received their first...

• CMS releases new, updated RAC FAQs

  CMS issued the following new RAC FAQ on its Web site September 30: If I am a chain provider whose...

• OIG plans to review Medicare, Medicaid auditing programs

  In 2010, the OIG plans to review the progress of many Medicare and Medicaid auditing programs, as...

• Have you been audited by a RAC?

  If you’ve been audited by a RAC—for example, if you’ve received a demand letter...

• Revenue Cycle Institute releases Observation white paper

  The Revenue Cycle Institute has released a new White Paper, “Inpatient or Outpatient Only...

Issue 20, October 1, 2009

• Last RAC announces first issues: DCS posts approved issues for Region A

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

• CMS releases new RAC FAQ

  CMS released the following new RAC FAQ September 25: How long is the Recovery Audit Contractor...

• CMS clarifies RAC exception authority

  On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...

• Providers seek information on Medicaid Integrity Contractors as aggressive auditing rolls out nationwide

  At this point, thanks to a three-year demonstration project and a plethora of available information...

• Revenue Cycle Institute posts new White paper and tool

  The Revenue Cycle Institute has released a new White Paper, “Sepsis and Septicemia: Clear Up...

Issue 19, September 17, 2009

• RAC issues approved for North Carolina

  Connolly, the RAC for Region C, approved several issues for North Carolina providers on September...

• Q&A: Medically Unlikely Edits and Once in a Lifetime codes

  Q: Several RACs are looking for once in a lifetime procedure coding errors. Wouldn’t...

• CMS releases transmittal on RACs and LCDs

  CMS released on September 11 transmittal 302, which outlines the authority RACs, MACs, and other...

• Revenue Cycle Institute launches new Web site, posts new RAC tool

  We’ve gathered the latest RAC information on the CMS-approved RAC issues in each state and...

Issue 18, September 3, 2009

• CGI posts first approved issues for RAC review in Region B

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

• RAC audit issues approved for Alabama, Georgia

  On September 1 Connolly, the RAC for Region C, has approved several issues for which it can audit...

• Connolly posts two RAC-approved issues for DME providers

  Connolly, the Region C RAC, has been approved to audit Durable Medical Equipment (DME) providers...

• Update: New issues approved for Florida

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

• MACs vs. RACs: Could a little friendly competition mean more bad news for healthcare providers?

  What’s the difference between a MAC and a RAC? When it comes to protecting Medicare dollars...

• CMS updates RAC FAQ

  CMS updated the three RAC FAQ on August 26.

• Revenue Cycle Institute posts free RAC tool

  Are you looking for help writing your RAC appeal letters? If so, the Revenue Cycle Institute hopes...

Issue 17, August 20, 2009

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

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

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

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

• CMS revises selection criteria for RAC adjustment crossover claims and fully reimbursable Part B claims

  On August 7, CMS issued transmittal R1793CP to modify one aspect of the logic that the Part A...

• Self-examination can help ensure compliance with new CMS-approved audit issues

  Connolly and HealthDataInsights (HDI) have released their first set of “approved...

• Trivia answer revealed: What do you know about the RAC Validation Contractor?

  Thanks to all who participated in our trivia contest in the previous issue of The RAC Report.

Issue 16, August 6, 2009

• RAC Audits to begin in Region C: Connolly posts issues eligible for RAC review

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

• Surprise! Voluntary refunds don't protect against RACs

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

• Avoid RAC technical denials to protect reimbursement

  Do not get a technical denial. Do not get a technical denial. Do not get a technical...

• FAQ: Appealing automated reviews

  Q: Can we appeal a RAC automated audit that results in a denial?

• Free Sample: RAC Tracking Spreadsheet

  Have you developed a way to manage the complex task of tracking your RAC requests and appeals? If...

• Answer and win! What do you know about the RAC Validation Contractor?

  Having a strong knowledge of RACs (e.g., what to expect, timelines, how to appeal, etc.) is...

Issue 15, July 23, 2009

• CMS releases two new FAQ on RACs and MACs

  CMS released two new FAQ on July 15. The questions are: If the incumbent Part B carrier is awarded...

• Let's discuss the RAC discussion period

  It seems that many providers still struggle to understand the RAC discussion period that CMS has...

• CMS clarifies how it will treat claims associated with denied inpatient stays

  CMS is often asked about other claim types that may be affected by a full inpatient denial and if...

• Revenue Cycle Institute releases POA White Paper

  The Revenue Cycle Institute has released a new white paper, “Present on Admission: Accurate...

• Medicaid Integrity Contractors: Coming to a hospital near you

  Nearly 500 Medicaid audits are under way in 17 states, and the program will roll out to the entire...

Issue 14, July 9, 2009

• CMS Releases RAC Audit Phase-in Strategy: Complex reviews to arrive as soon as August

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

• Physician advisors and RACs: Saving grace, defending dollars

  When it comes to surviving RACs, effective physician advisors can be a “saving grace,&rdquo...

• Revenue Cycle Institute posts free IPPE template

  Take advantage of a handy tool to ensure that your physicians don’t overlook Initial...

• Have you had an experience with Medicaid Integrity Contractors?

  If you’ve had experience with Medicaid Integrity Contractors (MIC), we want to hear from you!

Issue 13, June 25, 2009

• CMS updates Medicare Financial Management Manual RAC information

  On June 12, CMS updated the Medicare Financial Management Manual with information pertaining to the...

• Hospital shares experience, tips for surviving RAC audits

  One of the best ways to prepare for a RAC audit comes in learning from survivors. Elizabeth Lamkin...

• Q&A: RACs and Physician Offices

  Q. Our Midwestern physician practice that has more than 30 physicians. Are physician offices...

• Essential questions every HIM director should ask about RAC record requests

  When planning for RAC record requests, HIM directors should ask several essential questions.

• Reimbursement for medical record copying costs

  Q: If you submit requested medical records to RACs via CD, are you still reimbursed copying costs...

Issue 12, June 11, 2009

• Additional CMS RAC FAQ clarify provider questions

  CMS released 14 new RAC FAQ June 3.

• CMS postpones RAC complex reviews of medical necessity until 2010

  CMS anticipates RAC automated reviews will begin in late June and July, according to Marie Casey...

• CMS replaces the term 'observation status' with 'observation services'

  In the July 2009 quarterly updates, CMS revised portions of both the Claims Processing Manual and...

• Revenue Cycle Institute posts free ABN Audit Preparation tool

  Help ensure your facility properly obtains ABNs from patients for Medicare noncovered services with...

Issue 11, May 28, 2009

• CMS releases four new and updated RAC FAQ

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

• Q&A: RACs and InterQual

  Q: If my hospital is not using the latest InterQual criteria, could that chart be pulled by the RAC...

• Master wound care coding to prepare for RAC audits

  Coders should arm themselves with as much wound care and coding knowledge as possible to prepare...

• RACs and Medicare Advantage

  Q: Are the Medicare Advantage plans included in RAC audits?

• Take our survey; Be part of a comprehensive look at national RAC preparedness

  We invite you to take our comprehensive survey on what your facility is doing to prepare for the...

Issue 10, May 14, 2009

• CMS releases new RAC FAQ

  CMS released a new FAQ on the Recovery Audit Contractor (RAC) program April 29 with important news...

• News: CMS posts slide presentation, RAC Open Door Forum call transcript, recording

  CMS posted a RAC program slide presentation, “Recovery Audit Contractors (RACs) and Medicare...

• Top 10 lessons learned from the RAC demonstration program

  The RAC demonstration project has come and gone, but many providers learned valuable lessons during...

• Understand the new AHA RACTrac initiative

  The American Hospital Association (AHA) plans to launch a Web-based survey as part of a larger...

• Revenue Cycle Institute announces 'Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role of Physician Advisors'

  The “Medicare Compliance Forum: A Strategic Approach to RACs, Observation Status and the Role...

Issue 9, April 30, 2009

• CMS posts RAC Open Door Forum call transcript, recording

  CMS has posted the recording, transcript and other related information from the April 8 RAC Open...

• AHA issues Member Advisory on RAC program

  The American Hospital Association (AHA) has shared what it knows about RACs via a Member...

• Q&A: Medical record request limit calculations

  Q: We have been trying to calculate the outpatient hospital medical record request limits...

• Revenue Cycle Institute releases new White Papers on Incident to and E/M auditing

  The HCPro Revenue Cycle Institute has just released two new complimentary White Papers.

• Recovery Audit Contractor Defense conference recordings available

  Recordings of the following “Recovery Audit Contractor Defense: A RAC Readiness Summit&rdquo...

• Lawsuit says RACs violate CMS' own regulations

  Are RACs violating CMS’ own rules? Palomar Medical Center in Escondido, CA believes they are.

Issue 8, April 16, 2009

• CMS updates RAC outreach schedule, FAQs

  CMS has updated its RAC education and outreach schedule. The schedule contains new information...

• Tip: Ask the right questions to ensure an effective admissions review program

  Are you certain your admissions review program is as effective as it needs to be so you can avoid...

• Did you know . . . Five CMS RAC Open Door Forum facts

  According to CMS, as noted in the April 14 Medicare RAC Special Open Door Forum, the following are...

• New free tools and Revenue Cycle Institute updates

  If you haven’t visited the Revenue Cycle Institute Web site recently, now is a good time. In...

Issue 7, April 2, 2009

• CMS announces RAC Open Door Forums

  CMS will be holding two Special Open Door Forums on RACs for Part A and Part B providers in April...

• Revenue Cycle Institute releases new injection and infusion White paper

  The HCPro Revenue Cycle Institute released a new White paper on injection and infusion coding and...

• Q&A: RACs and critical access hospitals

  Q: How will the RAC audits affect critical access hospitals (CAH) seeing as they are paid on a per...

• Tip: Find out how non-hospital providers can get the RAC education they

  CMS has recently announced the first round of provider information and outreach sessions on RACs...

• Share your RAC appeal experiences

  If you’ve experienced RACs at your facility during the demonstration project, we want to hear...

• And the winner is . . .

  Thanks to all who participated in our contest! In the previous issue of The RAC Report, we featured...

Issue 6, March 19, 2009

• CMS rescinds and replaces previous RAC transmittal

  On March 6 CMS issued Transmittal 148 rescinding and replacing previous instruction regarding the...

• Q&A: RACs and readmissions

  Q: A provider does three different procedures in three different days. Is this acceptable? Are RACs...

• Tip: Have clear documentation when sepsis or SIRS is POA

  Never assume that sepsis is present on admission (POA). Sepsis or severe sepsis may be present on...

• Test your RAC knowledge to win

  Think you know everything there is to know about RACs? Test your knowledge and enter to win!

Issue 5, March 5, 2009

• CMS releases new and updated RAC FAQs

  CMS released six new and updated FAQs related to RACs on February 17, 20 and 27.

• Tip: Look into the future

  RACs cannot randomly select or target a claim “solely because it is a high-dollar...

• Provider Q&A: Directing RAC correspondence

  Q: How does a RAC denial notice come into your system? Does it go to the CFO or CEO, or to the...

• Revenue Cycle Institute update

  Have you visited the Revenue Cycle Institute Web site lately?

• Trivia winner announced!

  Find out the answers to the trivia questions we asked in the previous issue of The RAC Report.

Issue 4, February 19, 2009

• In case you haven't heard...

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

• Tip: Tune in to RAC outreach sessions and town hall meetings

  The announcement from CMS officially kicks the RAC program back into gear. Hospitals and providers...

• Understand diagnosis coding to protect against auditor scrutiny

  When coding for outpatient procedures, coders should base the patient’s diagnosis on his or...

• Trivia: RAC your brain for a chance to win!

  Editor’s note: Answer all the questions correctly and submit your answer on or before...

Issue 3, February 5, 2009

• Q&A: News on the permanent RAC program

  Q: Is there any news on the new start-up date for the permanent RAC program? If not, when do we...

• Tip: Address one-day stays before the RAC permanent program begins

  It is no secret that RACs focused on one-day stays in the demonstration project. So what are you...

• Help ensure RAC-friendly inpatient coding: The importance of discharge notes

  Most inpatient coders are accustomed to seeing “probable,” “suspected,&rdquo...

• Sample tools, e-mail news updates, and more

  We’ve added several new features to our Revenue Cycle Institute Web site...

Issue 2, January 22, 2009

• Take note: 10 RAC facts to consider

  Consider the following 10 RAC facts as you prepare for RACs to go live in your area.

• Q&A: RAC information for long term care facilities

  Q: Most of the RAC information I have seen has been geared to the hospitals, and rightly so. But do...

• Understand the intricacies of medical necessity

  Medical necessity is complex because there is debate regarding what constitutes...

• Did you know?

  Did you know about the Revenue Cycle Institute blog? You’ll find tons of news, loads of tips...

Issue 11, January 8, 2009

• Update: CMS releases updated RAC demonstration report

  On January 6 CMS released an update to its three-year RAC demonstration program report previously...

• Tip: Hire a physician liaison to jump-start your RAC efforts

  One item that appears to be missing from most HIM directors’ RAC preparation checklist is a...

• Q&A: RAC automated reviews

  Q: Under what circumstances can a RAC make a finding that an overpayment or underpayment exists...