Q&A: RAC automated reviews
Patient Financial Services Weekly Advisor, January 9, 2009
Q: Under what circumstances can a RAC make a finding that an overpayment or underpayment exists without requesting medical records?
A: RACs may use automated review (where no medical record is involved in the review) only in situations where there is certainty that the claim contains an overpayment. Automated review must meet one of the following criteria:
- Have clear policy that serves as the basis for the overpayment (“clear policy” means a statute, regulation, National Coverage Determination, coverage provision in an interpretive manual, or Local Coverage Determination that specifies the circumstances under which a service will always be considered an overpayment)
- Be based on a medically unbelievable service
- Occur when no timely response is received in response to a medical record request letter
Editor's note: This Q&A was excerpted from the CMS Web site. For additional RAC Q&A, click here.
Comments
0 comments on “Q&A: RAC automated reviews ”
Related Products
-
Medicare Audits in Long-Term Care: A Guide to MACs, RACs, and ZPICs
This book describes the different types of Medicare audits that nursing homes face and helps you take a proactive approach...
-
Combat RAC Denials: Strategies for Successful Appeals
During this 90-minute audio conference, our speakers provide step-by-step procedures, timelines, tools, and best practices...
-
2014 IPPS Final Rule Explained
The sheer volume of new payment and quality information, along with new patient status proposals that will be in the 2014...
-
Manage Revenue Integrity and Audit Activity
During this 90-minue audio conference, our speakers will explain how to work across departments and build a strong revenue...
-
PEPPER for Critical Access Hospitals: Identify Your Audit Risk
During this 90-mintue audio conference, our speakers will explain PEPPER and tell you how to use your report to identify...
Most Popular
- Articles
-
- CMS seeks comment on quality measures
- Practice the six rights of medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Don't forget the three checks in medication administration
- OB services: Coding inside and outside of the package
- ICD-10-CM coma, stroke codes require more specific documentation
- Nursing responsibilities for managing pain
- Q&A: Primary, principal, and secondary diagnoses
- Skills of effective case managers
- Clearing up the confusion: CPT codes 76376 and 76377
- E-mailed
-
- Coronavirus vaccination: 4 best practices for communicating with patients
- Grievances, Complaints, and Patients’ Rights
- Keyes Q&A: Generator lighting, fire dampers, eyewash stations, ISLM fire drills
- Including 46600 in E/M leveling systems
- Five keys to creating a CHF disease management program
- Fetal non-stress tests represent important part of maternal and fetal health
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Know how to correctly code each procedure an otolaryngologist can perform on turbinates
- Coding Clinic reiterates guidelines for provider documentation
- CMS creates web portal for questions about 1135 waivers, PHE
- Searched