Case Management

News: Region B RAC posts first set of medical necessity issues

Case Management Weekly, August 18, 2010

CGI Technologies and Solutions, Inc., of Fairfax, VA, the Region B recovery audit contractor (RAC), recently posted the first set of approved medical necessity issues on its website. This occurred days after the American Hospital Association announced that CMS approved the initial review audits.

Providers have been waiting for the approved issues since spring. During a May CMS Open Door Forum call, a CMS representative said that CMS had received but not yet approved medical necessity issues.

“This is very consistent with the pattern we’ve seen with RACs since the roll out of the permanent program,” says Michael Taylor, MD, senior medical director of government and regulatory affairs at Executive Health Resources in Newtown Square, PA. “CMS has been very deliberate in vetting the subjects that RACs are allowed to review.”

Eighteen issues for medical necessity review were posted on the CGI website, and all but one of them comes as no surprise, according to Taylor.

Read more at the Revenue Cycle Institute

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