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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.
Click to view video
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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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RAC Preparedness: It Takes a Team!
By Nancy Hirschl, CCS, and Lori Brocato
The 2nd installment of the RAC Ready column for Advance Magazine is available online. Click here to read the article.
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The RAC Program is Back on Track!
As Quoted from the CMS website
Protest Resolved: On February 4, 2009 the
parties involved in the protest of the award of the Recovery Audit
Contractor (RAC) contracts settled the protests. The settlement means
that the stop work order has been lifted and CMS will now continue with
the implementation of the RAC program.
Under
the program, the four RACs will contract with subcontractors to
supplement their efforts. PRG-Schultz, Inc. will serve as a
subcontractor to HDI, DCS and CGI in regions A, B and D. Viant Payment
Systems, Inc. will serve as a subcontractor to Connolly Consulting in
region C. Each subcontractor has negotiated different responsibilities
in each region, including some claim review.
The RAC in each jurisdiction is as follows:
Region A: Diversified Collection Services (DCS)
Region B: CGI
Region C: Connolly Consulting, Inc.
Region D: HealthDataInsights, Inc.
All correspondence, websites and call centers will be in the name of the RACs above.
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HealthPort's Lori Brocato and Nancy Hirschl Start a New RAC Column for Advance magazine
In each column, Lori and Nancy will share their knowledge with you, the
health information professional. The column will serve as a monthly survival guide for Medicare's recovery audit contractor (RAC) program. The goal is to help hospitals prepare for, manage and cope with RAC throughout the coming year. As a RAC consultant in the state of California and a leading release-of-information service provider, both companies have been heavily involved with RAC since the first record request was received and the first audit was conducted nearly 4 years ago. A lot has changed and a lot of lessons have been learned.
With RAC, the burden falls on each facility to protect reimbursement dollars and stay ahead. Our column can help. Over the next 12 months, we'll explore important RAC topics such as:
* The Three Steps to RAC Preparedness
* Managing RAC Demands: Human and Technological
* Improving Clinical Documentation for RAC
* Compliance and Winning Physician Cooperation
* The Who, What and When of Appeals
* Deciding if an Appeal is Worth the Work
Click here to read the first article: Are You Ready to RAC?
We invite you to visit our column
every month and uncover the know-how, skills and techniques you need to
help your organization thrive under RAC. We will link to the articles in this blog when they come available so check back often!
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Updated Medicare RAC Demonstration Report
CMS recently released the January 2009 update to the Medicare RAC Demonstration Report.
The update document outlines current Medicare appeals statistics and claim
RAC’s through August 2008 and lists statistics with respect to provider appeals of RAC initiated overpayments. CMS also reports that changes in appeals reporting are being implemented for appeals tracking in the permanent RAC program.
Additionally in the update, CMS indicates that it is unable to determine the amount of appeals ending at the first level of appeals; however, the majority of first level appeals should have been filed by July 1, 2008. As a result, CMS plans on updating the above appeals statistics until all appeals have completed the Medicare appeals system.
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"RAC in the Real World" Panel Discussion Video Now Available
In October, during AHIMA’s Product World meeting in Seattle, HealthPort brought together an expert panel to discuss “RAC in the Real World,” real-world advice on RAC Preparedness.
In partnership with Nancy Hirschl, RHIT, CCS-P, President, Hirschl and Associates, the panel shared experiences from the demonstration project with an emphasis on how organizations can prepare for auditors, mitigate their risk for revenue reduction, and manage the administrative burden of RAC. Panel members include Ms. Carol Richardson, MA, RHIA, Director of Health Information Management and Corporate Policy official from Adventist Health in California; Mr. Lane Edenburn, Executive Vice President and General Council of Health Data Insights (HDI); and Mr. Stanley Padfield, RHIA, HIM Director for Lee Memorial Hospital. HDI is one of the four original RACs that participated within the pilot program and was chosen to be part of the permanent RAC expansion.
A podcast and a complete video of HealthPort's Product World session are now available. Click here to listen to the podcast or click here to watch the video of the valuable information offered to AHIMA’s Product World attendees.
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CMS Releases Transcripts of recent Open Door Forums on RAC Contractors
In an effort to introduce providers to the new RAC contractors and offer more information about the Medicare RAC program, CMS recently held two Open Door Forums. During the forums, several participants requested documentation reflecting the Medicare appeals process associated with a RAC improper payment determination. As a result, CMS supplied the requesters with an appeals process chart.
CMS has made the transcripts of these Open Door Forums available through the following links:
• November 12, 2008 Special Open Door Forum for Part A providers
• November 13, 2008 Special Open Door Forum for Part B providers
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CMS discusses limits on medical record requests by RACs
During an AHA member call today to discuss the nationwide rollout of the permanent Medicare recovery audit contractor program, Centers for Medicare & Medicaid Services staff announced limits on the number of medical records the RACs will be allowed to request from providers.
For inpatient claims, the maximum number of records RACs may request will vary by the hospital's national provider identifier and will equal 10% of average monthly Medicare claims. The RACs will not be able to request more than 200 records in a 45-day period for both inpatient and outpatient claims combined. Providers with more than one NPI may face a unique record limit per NPI; however, CMS staff said they plan to provide further clarification on this policy.
Earlier this month, CMS announced the names of the permanent RACs and revised plans for the nationwide rollout. Hospitals in the first phase of the rollout may begin to receive requests for medical records or reimbursement of overpayments as early as December. For more on the RAC program, visit
http://www.aha.org/aha/issues/RAC
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HealthPort Pulls Together Expert Panel to Discuss RAC
AHIMA National Convention Sets Stage for Real-World Advice on RAC
Preparedness
HealthPort will
host 2 informative sessions about the RAC program and HealthPort's new RACPro Solution
at this year's Association
for Health Information Management Association's
(AHIMA) Convention and Exhibit in Seattle, Washington. In partnership
with Nancy
Hirschl, RHIT, CCS-P, President, Hirschl
and Associates, the panel will share real-world experiences from
Medicare's RAC demonstration program with an
emphasis on how organizations can prepare for auditors, mitigate their
risk for revenue reduction, and manage the administrative burden of RAC.
Panel members include Ms.
Carol Richardson, MA, RHIA, Director of Health Information
Management and Corporate Policy official from Adventist Health in
California; Mr.
Lane Edenburn, Executive Vice President and General Council of
Health Data Insights (HDI); and Mr.
Stanley Padfield, RHIA, HIM Director for Lee Memorial Hospital. HDI
is one of the four original RACs that participated within the original
pilot program. In addition, it was announced yesterday that HDI would be
part of the permanent RAC expansion.
Click Here to view our press release
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RAC Permanent Program
On October 6, 2008, CMS announced the names of the new national RACs:
- Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York.
- CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.
- Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
- HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.
Click Here for More Details
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CMS Appeal Update to 3 Year Evaluation
CMS Update: Appeal Update of previously released 3 year RAC Evaluation Report
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CMS Announces New Timeline for Permanent RACs
At a meeting of regional, state and metropolitan hospital executives in Washington, D.C., Centers for Medicare & Medicaid Services Office of Financial Management Director Tim Hill announced a revised timeline for the nationwide rollout of the permanent recovery audit contractor program.
Click Here to View the Presentation by Tim Hill
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This just in from the Centers of Medicare and Medicaid Services (CMS)
Press Release: New Report Shows CMS Pilot Program Recovering Nearly $700 Million in Improper Medicare Payments
Report: The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-year Demonstration
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Nancy's RAC Executive Update Presentation
Nancy recently spoke at a HealthPort-sponsored event.
View her RAC Executive Summary here.
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Next RAC announcement expected within weeks
Next RAC announcement expected within weeks. Expect news about CMS awarded RACs, start-up and final implementation dates.
Medicare expects to make their next announcement about RAC audits in June 2008. Based on recent activity and national feedback, we expect to hear final word regarding CMS RAC awarded contracts, implementation dates, and any final rules and regs related to RAC operations. If you are attending HFMA's ANI conference in Las Vegas, join me for an executive update on Monday, June 23rd.
Providers in the RAC Pilot program have identified extensive financial and administrative issues regarding the internal needs faced in meeting RAC demands including:
- Incorrect coding;
- Insufficient physician documentation;
- Unsupported medical necessity;
- Inappropriate patient status designation;
- Clerical support staffing (medical record location and photocopying);
- RAC process and outcomes tracking;
- Internal coding, case management, and billing auditing; and
- Rebuttal and Appeals processing.
Which of these issues have been the most difficult to manage for your organization?
RAC audits come with hefty back-office, record management and staffing price tags.
We've heard feedback from many providers in early RAC states that the administrative burden associated with keeping track of RAC audit activity is costing thousands of dollars a month. Responding to inquiries, finding and photocopying medical records, and tracking communication with the RAC takes time and money. There are overwhelming manpower costs to comply with auditor demands. Some organizations have assigned a RAC Manager to the task. Technology to track all the records is minimal with most organizations relying on Excel spreadsheets. What is your organization doing to manage the administrative burden associated with RAC audits?
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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
03.01.09 - RAC Preparedness: It Takes a Team!
02.06.09 - The RAC Program is Back on Track!
01.29.09 - HealthPort's Lori Brocato and Nancy Hirschl Start a New RAC Column for Advance magazine
01.05.09 - Updated Medicare RAC Demonstration Report
12.15.08 - "RAC in the Real World" Panel Discussion Video Now Available
12.03.08 - CMS Releases Transcripts of recent Open Door Forums on RAC Contractors
10.22.08 - CMS discusses limits on medical record requests by RACs
10.07.08 - HealthPort Pulls Together Expert Panel to Discuss RAC
10.06.08 - RAC Permanent Program
09.15.08 - CMS Appeal Update to 3 Year Evaluation
09.07.08 - CMS Announces New Timeline for Permanent RACs
07.11.08 - This just in from the Centers of Medicare and Medicaid Services (CMS)
06.30.08 - Nancy's RAC Executive Update Presentation
06.11.08 - Next RAC announcement expected within weeks
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