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.
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.
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information.
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