RACMonitor.com Recovery Audit Contractors RAC News and Informations Services

New Clinical Documentation Requirements for Resource Rich Inpatient Rehab Services

Inpatient rehabilitation facility (IRF) services are intended for patients requiring a resource-rich environment due to their complex nursing, medical and rehabilitation management needs. Read more

When to Call in the Big Guns: RAC Preparedness and Outsourcing

Okay, you've followed all the advice and you're prepared for the RACs, the ZPICs, the MACs, the MICs. You've created a RAC team, drafted policies and procedures, done trial work flow processes, and sat in on who-knows-how-many webinars and conferences on how to prepare for governmental audits. Read more

RAC-Approved DRG Validation Issues: Who and What’s At Risk Now

The RACs recently posted more than 560 of the current 746 MS-DRGs approved for DRG Validation, offering analysis of DRG coding, principal diagnoses, secondary diagnoses, and all diagnoses and procedure codes that could affect the DRG selection. While none of the RACs appear to be approved for medical necessity review so far, according to the CMS RAC Review Phase-in Strategy published by CMS in June 2009, they are expected to be approved sometime in "calendar year 2010." Read more

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This Week's Top Stories are sponsored by: Panacea Healthcare Solutions, LLC.

Feb

2010

RACs to Establish Per Campus Caps

Written by Barbara Vandegrift, RN, BSN, MA

The recent announcement by CMS regarding its modification of additional documentation requests for institutional providers during fiscal year 2010 has generated considerable response from providers seeking clarification about tax identification numbers and definitions of terms like "campus."
Last Updated ( Monday, 08 February 2010 19:40 )
Read more...

Feb

2010

Is It Worth the Effort to Rebut RAC Findings?

MBrown cservais120ds By: Margi Brown, RHIA, CCS, CCS –P, CPC, CCDS
and Cheryl E. Servais, MPH, RHIA

In a word - YES. Our preliminary statistics indicate that more than half of RAC findings for complex reviews should be rebutted due to documentation that was overlooked or guidelines that were not applied correctly.

Last Updated ( Wednesday, 03 February 2010 17:18 )

Feature Stories

Preparing Records for RAC Scrutiny – The Role of the Physician Query

George Kelley | Monday, 28 December 2009

By: George L. Kelley, MS, MBA In preparing your facility for RAC reviews, our organization has supported and championed a data mining approach that will identify specific cases at risk for review by the RACs. Once these cases are identified, they need to be examined to determine: Do...

Federal Government Ramps Up to Review Medicare and Medicaid Error Rate Data

Carla Engle, MBA | Wednesday, 9 December 2009

In this era of reducing improper healthcare payments, providers obviously are gearing up for some major league defense against the RACs, ZPIC, MICs and other governmental auditing bodies by shoring up their coding and billing practices. But there also have been some recent developments on the other side of the...

News Analysis

The RAC Recoupment Rollout: It Already Started, Before the Letters Were Sent

Samuel A. Donio, Jr., MBA | Wednesday, 9 December 2009

This time last year, in the first RACMonitor edition, I discussed the potential rollout of the RAC recoupment process on a regional and state-specific basis. As we all are well aware, the original rollout plans never came to fruition, but I would venture to say that maybe the RAC recoupment...

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