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RAC News & Updates
Lori Brocato is currently HealthPort's RCM and RACPro Product Manager and serves as our resident expert on the Recovery Audit Contractor (RAC) program. In 2009 Lori served as a monthly co-contributor in Advance Magazine for Health Information Professionals' e-newsletter, RAC ready column, that served as a "monthly RAC survival guide."
With posts to the RAC blog, HealthPort helps hospitals plan for, track and deal with RAC audits. We are committed to your success under Medicare's RAC program. Check this page often for the latest news, education and free Webinars about RAC.
CMS expands fiscal year 2010 RAC ADR limits to all institutional providers
Announced in December, the 2010 fiscal year documentation limits applied only to requests for DRG validation purposes. Recently announced on January 29, 2010 via the CMS Website, these limits have been expanded to include the same methodology for reviews of all institutional claim types. CMS indicates that more changes are to come at a later date. Click on the link below to review the additional documentation limits for fiscal year 2010.
RAC ADR limits expanded to all institutional providers
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RAC News & Updates January 2010
RAC welcomes 2010 with important news for Region C and Region D providers
Health Data Insights (HDI) and Connolly recently posted new approved issues for review on their respective websites. The announcements are further indication that 2010 will be a busy year for providers; particularly for complex reviews involving MS-DRG coding and DRG validations. Medical necessity reviews are specifically excluded from review at this time.
The recovery audit contractor for Region D, HDI posted 66 new approved issues on January 6th, 2010. Issues represent both medical and surgical cases and cover 530 MS-DRGs, over 70 percent of all DRGs. Likewise Connolly, the Region C contractor, informed providers in the Southeast that several new issues had been approved for a total of 59 DRG validation issues now listed on their website.
HealthPort recommends that providers in all regions keep a close watch on RAC websites and get fully prepared for complex reviews. In fact, several Region C states have reported receipt of medical record and additional documentation request letters. Here are a few simple measures to help you prepare and reduce your RAC risk in 2010:
- Review all approved issues for your region.
- Conduct internal audits for coding and DRG validation based on the approved issues list.
- Physician documentation remains key to successful appeals - conduct documentation audits and physician education as necessary based on internal review and audit findings.
Welcome to 2010 and stay tuned as HealthPort covers all the important recovery audit news.
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Introducing RACPro 2.5, a unique combination of enhanced functionality and AHA RACTrac compatibility
Coupled with the RACTrac compatibility designation, the new RACPro 2.5 enhances the recovery audit contractor (RAC) management process and further expands communication capabilities so that healthcare facilities can respond to RAC requests effectively and in a timely manner. Some of the new features include:
- Billing and Coding-Enables a side by side comparison of what was billed versus what the RAC is reporting to help facilities easily find and review discrepancies.
- Extension Requests-Allows accurate management of extension request and associated timetables.
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Region C, Connolly Healthcare, Posts CMS-Approved Audit Issues
Connolly Healthcare recently posted twenty-four, CMS-approved audit issues. Providers in Region C should check the Connolly website for more information, ensure your contact information is correct with Connolly (who should receive request letters), and review Connolly instructions and timelines. Many of the issues are the same as those reviewed during the demonstration project and came as no surprise to HealthPort experts.
Click here for more detailed information.
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CMS Announces Record Limits for Providers
On December 2, 2009, CMS made an important announcement for providers regarding the number of records that can be requested every 45 days by recovery audit contractors (RACs). The new limits are based on a percentage of Medicare claims and campus units. Most importantly for healthcare providers, the new limits may result in more documentation requests to fill and more appeals to process.
According to CMS, a campus unit may consist of one or more separate facilities/practices operating under a single Tax ID Number (TIN), but be physically located within zip codes displaying the same first 3 digits. Locations outside of the same first 3 zip code digits represent a second "campus unit", regardless of TIN.
To identify the maximum number of records that RACs can request every 45 days, providers should calculate 1% of all claims (inpatient and outpatient) submitted to Medicare per campus unit for the prior fiscal year; and divide this number by eight. This number represents the maximum records the RAC can request from each campus unit every 45 days. There is a cap of 200 requests through April 1, 2010 per campus unit and 300 requests per campus unit from April 1 until October 1, 2010; although RACs can request permission from CMS to exceed the cap after the first six months of the fiscal year.
Click here for more detailed information.
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RACPro 2.3 Release is RACTrac Compatible through the AHA
With the release of 2.3, HealthPort RACPro now holds the distinction, through the American Hospital Association (AHA), of being RACTrac Compatible, an indicator of the ability to gather the entire data of a hospital’s RAC experience in a way that is compatible with AHA’s RACTrac survey questions.
RACTrac compatibility gives hospitals the ability to report to the AHA, on a quarterly basis, their RAC experience. This RAC report captures critical information to support the AHA’s efforts to improve the RAC program giving RACPro an opportunity to assist with shaping the future of the RAC process.
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Introducing RACPro 2.3
Introducing RACPro 2.3...added functionality to reduce the stress of RAC management.
Some Benefits:
- Enhanced customer fields
- Customer e-mail triggers
- Auto populate features
- Coder & Physician lists...and more
Each new feature was designed to help manage requests, streamline communication and reduce the instances of errors and missed deadlines.
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HealthPort Achieves Executive Health Resources Integration Certification
We are excited to announce our recent certification as an approved Executive Health Resources (EHR) Integrated vendor. EHR developed EHR Integrated as a certification program established to help their hospital clients easily identify vendors, like HealthPort, whose RAC Management Products transmit and receive data and images to facilitate the appeals process. EHR integration certification validates that HealthPort RACPro provides seamless inbound and outbound data exchange to reduce clients’ appeals data processing time, maintain data integrity and allow them timely access to appeals process status.
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HealthDataInsights, Inc, the RAC for Region D, has initiated automated audits.
HealthDataInsights, Inc, the
RAC for Region D, has initiated automated audits. Issues approved by CMS are as follows:
- Newborn Pediatric CPT
Codes Billed for Patients Exceeding Age Limit. Description:
Certain service codes are specific to patients of a specific age and
should not be applied/billed for patients which exceed the age limit
defined by the CPT Code.
- Once in a Lifetime.
Description: Certain procedures are only performed once in a person’s
lifetime.
- Excessive
Units-Untimed Codes. Description: When reporting services
units for untimed codes (excluding Modifiers –KX, and -59) where the
procedure is not defined by a specific timeframe, the provider should
enter a 1 in the units bill column per date of service.
- Excessive Units-Blood
Transfusion. Description: Blood Transfusions
should be billed with a maximum of (1) unit per patient per date of
service.
- Excessive Units. Description: Bronchoscopy services should be
billed with a maximum number of units (1) per patient per date of service
- Excessive Units – IV
Hydration. Description: IV Hydration should be billed with
a maximum number of units (1) per patient per date of service.
- Neulasta.
Description: Neulasta (HCPCS Code J2505) Claims submitted with the total
number milligrams instead 1 unit per 6 mg. Claims for J2505 should be submitted so that the units
billed represent the number of multiples of 6mg administered, not the
total number of mgs.
Click Here for more detailed
information.
Not sure what region you are in?
Click here to view the map
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Connolly Healthcare Posted the First Set of Issues Eligible for RAC Review
Connolly Healthcare, the RAC for Region C, has posted the first set of issues eligible for RAC Review on its Website.
- Blood transfusions. Description: CPT codes 36430, 36440, 36450, and 36455 (excluding claims with any modifiers) as one per session, regardless of the number of units transfused on that date of service.
- Untimed codes. Description: CPT codes, excluding modifiers -KX and -59, where the procedure is not defined by a specific time frame (i.e., untimed codes). The provider should enter a one(1) in the units billed column per date of service.
- IV hydration therapy. Description: Based on the definition CPT code 90760, the maximum number of units should be one per patient per date of service (excluding claims with modifier -59).
Note: Beginning January 1, 2009, code 96360 replaced code 90760.
- Bronchoscopy services. Description: CPT codes 31625, 31628, and 31629 should be billed with a maximum number of units of one per patient per date of service (excluding claims with modifier -59).
- Once-in-a-lifetime procedures. Description: By virtue of the description of the CPT code, providers may only perform these codes once per patient lifetime.
- Pediatric codes exceeding age parameters. Description: Newborn and pediatric CPT codes billed or applied to patients who exceed the age limit defined by the CPT code.
- J2505 (Injection, Pegfilgrastim, 6 mg). Description: By definition, HCPCS code J2505 represents 6 mg per unit. Providers should bill the code at one unit per patient per date of service.
Click Here for more detailed information.
Not sure what region you are in?
Click here to view the map
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02.10.10 - CMS expands fiscal year 2010 RAC ADR limits to all institutional providers
01.26.10 - RAC News & Updates January 2010
12.16.09 - Introducing RACPro 2.5, a unique combination of enhanced functionality and AHA RACTrac compatibility
12.08.09 - Region C, Connolly Healthcare, Posts CMS-Approved Audit Issues
12.08.09 - CMS Announces Record Limits for Providers
10.12.09 - RACPro 2.3 Release is RACTrac Compatible through the AHA
10.06.09 - Introducing RACPro 2.3
08.25.09 - HealthPort Achieves Executive Health Resources Integration Certification
08.17.09 - HealthDataInsights, Inc, the RAC for Region D, has initiated automated audits.
08.06.09 - Connolly Healthcare Posted the First Set of Issues Eligible for RAC Review
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