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RAC News & Updates
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HealthPort has partnered with Nancy Hirschl, a widely recognized industry expert on the Recovery Audit Contractor (RAC) expansion.
Working together with Nancy, 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.
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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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HealthPort Webinar, "Mitigate RAC Financial Risk," is Now Available Online
Presented by:
Lori Brocato, Product Manager, HealthPort
Donna Didier, Auditing & Education Consultant
RACs are Here!
Mitigate your financial risks by understanding what they're looking for.
Do you have a plan in place for optimal response, tracking, storage and management of these requests? What about the Appeals Process – do you know what to expect and what you should do? There is a lot to learn, and being prepared is key.
Register now to view the webinar and gain valuable insight and direction on the RAC review process.
Click here to view the previously-recorded webinar.
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CMS Provides New Details About the Phase-in Strategy
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Earliest possible dates for reviews
in Yellow/Green states
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Earliest possible dates for reviews
in Blue states
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Description
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Dates
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Description
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Dates
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Automated Review – Black & White Issues
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June 2009
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Automated Review – Black & White Issues
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June 2009
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DRG Validation – Complex Review
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Aug/Sept 2009
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DRG Validation – Complex Review
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Oct/Nov 2009
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Complex Review for coding errors
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Aug/Sept 2009
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Complex Review for coding errors
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Oct/Nov 2009
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DME Medical Necessity Reviews – Complex Review
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Fiscal Year 2010
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DME Medical Necessity Reviews – Complex Review
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Fiscal Year 2010
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Medical Necessity Reviews – Complex Reviews
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Calendar Year 2010
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Medical Necessity Reviews – Complex Reviews
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Calendar Year 2010
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Not sure what color your state is?
Click here to view the map
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HealthPort's Lori Brocato Featured on Healthcare IT News
Video: HealthPort on Recovery Audit Contractors
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Lori Brocato, RCM Product Manager at HealthPort, discusses how revenue cycle management can prepare an organization for a visit from recovery audit contractors.
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CMS anticipates automatic review to start in late June or July.
Complex reviews for medical necessity – early 2010
In a recent meeting between AHA and CMS, several updates were provided on the Recovery Audit Contractors. To read the complete report, click here.
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HealthPort Webinar, "Get Ready for RAC," is Now Available Online
"Get Ready for RAC," presented by Lori Brocato, is an informative presentation that will help you better understand and manage the recovery audit contractor (RAC) permanent program in your facility.
During this taped webinar you will learn:
- What RACs are focused on
- What you need to prepare for the RAC process
- Appeals process guidelines
- Technology and tools you will need to streamline the RAC process
View the previously recorded webinar or download a PDF slideshow of it.
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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
07.17.09 - HealthPort Webinar, "Mitigate RAC Financial Risk," is Now Available Online
06.24.09 - CMS Provides New Details About the Phase-in Strategy
06.17.09 - HealthPort's Lori Brocato Featured on Healthcare IT News
06.01.09 - CMS anticipates automatic review to start in late June or July.
04.10.09 - HealthPort Webinar, "Get Ready for RAC," is Now Available Online
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