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.
They're Here! Medical Necessity Review
Last week, CGI issued a list of 18 inpatient hospital claims medical necessity reviews to state hospital associations in RAC Region B states (Illinois, Indiana, Kentucky, Ohio, Michigan, Minnesota and Wisconsin). Click on the link below to access the list:
http://www.aha.org/aha/content/2010/pdf/100813-new-issue-racb.pdf
As the audits commence in Region B states, all providers can soon expect the same announcement from their own RACs. Hospitals in the other three RAC regions are encouraged to monitor their RAC's website for information on the new audits. Contact information for the four regional RACs can be found at www.aha.org/aha/issues/RAC/contractors.html.
Particularly of importance is that all of these MS-DRGs include both the DRG Validation and Medical Necessity review and half of them were previously approved as DRG Validation only. Insight into what patterns RACs may be seeing when reviewing medical records for other issues? Stay tuned!
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Nine New RAC Issues Were Recently Posted by Connolly Healthcare
For outpatient / physician claims:
- Zoledronic acid (Reclast), 1 mg – dose vs. units billed – overpayment.
- Adenosine – dose vs. units billed (6 mg).
- Pamidronate disodium – dose vs. units billed.
- Tenectplase – dose vs. units billed.
- Paclitaxel protein-bound particles – dose vs. units billed.
- Cetuximab – dose vs. units billed.
- Paclitaxel – dose vs. units billed.
For DRG validation claims:
- Endocrine, nutritional & metabolic disorders.
- Disorders of pancreas except malignancy without CC/MCC: MS-DRG 440.
For more detailed information go to Connolly's website. You can also access additional updates from other RACs by clicking the links below:
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Launch of HealthPort AudaPro
Last week we announced the launch of HealthPort AudaPro, our powerful Web-based audit management tool that includes our #1 selling RAC management solution, HealthPort RACPro. Designed to mitigate the stress related to managing the many audits that negatively affect the revenue of healthcare facilities, HealthPort AudaPro streamlines the entire audit process.
Click here to access the press release about the launch.
Click here to learn more about AudaPro.
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The RAC program makes 2010 a tough and busy year for health care providers
CMS has extended the RAC program to all 50 states by no later than 2010. Are you worried about the extra resources and finances that it will take to cope with impending RAC program audits? You must consider the impact that RAC will have on your HIM department. Click here to read an insightful article recently featured in Advance for Health Information Professionals online newsletter. Co-authored by Jonathan Arkin, Vice President of Business Development, the article, “The RAC Burden on Your HIM Department” outlines the steps involved in the RAC process and the impact it will have on hospital HIM departments.
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Audit Advice Column: The Expansion of Recovery Audits
Recovery audits are the new reality for healthcare providers. This month's Audit Advice Column, featured in Advance for Health Information Professionals online newsletter and authored by HealthPort's resident RAC expert, Lori Brocato, takes a look at three important recovery audit programs: Medicaid Integrity Contractors (MICs), Medicare Administrative Contractors (MACs) and Medicare Advantage Plan audits.
Click here to read the full article.
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AHA RAC Update: CMS Announces Nationwide RAC 101 Calls
Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced a series of Nationwide RAC 101 Calls. See below for dates and times. We encourage you to participate in the calls and use the opportunity to ask any questions you have regarding the permanent RAC program.
- April 28, 2010 1:00 pm - 2:30 pm EST: Nationwide RAC 101 Call: 1-877-251-0301
- May 4, 2010 1:00 pm - 2:30 pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers: 1-877-251-0301
- May 5, 2010 1:00 pm - 2:30 pm EST: Nationwide RAC 101 Call for DMEPOS: 1-877-251-0301
- May 12, 2010 1:00 pm - 2:30 pm EST: Nationwide RAC 101 Call for Physicians: 1-877-251-0301
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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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