Updated on: June 22, 2012

Don’t Play the Blame Game

Original story posted on: February 16, 2009

busmanglasses_smLatest Update from RACUniversity:

Coding Errors Could Cost Your Facility


Of the $980 million in overpayments recouped by the RACs, $331 million, or about 35 percent, was the result of incorrect coding.


Now, with the RACs back on track, your facility needs to protect itself from the kinds of coding errors that could cause grief, heartache and risk - legally and financially. Don't play the blame game when it comes to coding!

Begin now, before the RAC program resumes, with coding education for your facility from RACMonitor UniversityTM, powered by eduTrax®.


Lessons Learned Through Education

At RACUniversity, we have prepared nine must-have courses for everyone who touches medical records. These courses are organized to help you undertake necessary preparation for the RACs.


The first of three eCourses, The Prep Pack, focuses on lessons learned from the RACs, especially on the subject of significant overpayments and the lack of documentation to support medical necessity.


The second and third eCourses, Coding and Billing for Principal Diagnosis and Coding and Billing for Secondary Diagnoses, discuss how the RACs used data scrubbers to identify claims that had the highest probability of DRG changes: the reverse of an encoder.


Principal Diagnosis: The Problem Starts Here


From an inpatient perspective, the principal diagnosis is one of the main drivers that determine payment. If the principal diagnosis is wrong, the facility responsible could be paid incorrectly and therefore, the door is open for RACS recoupment. That makes sense.


Now add the new wrinkle: MS-DRGs. As you may know, the CMS DRG payment methodology changed in FY 2008 to Medicare Severity, or MS-DRGs. This date is also significant in that it is the base year for the RACs, meaning claims paid from Oct. 1, 2007 onward are open to RACs scrutiny! Are you prepared?

Other eCourses

In addition to the three highlighted eCourses, others in the special curriculum include...
Coding and Documentation Hot Spots: Learn what the RACs attacked during the demonstration.


  • Medically Unlikely Edits: At last count, there were over 8,000, with more to be added. It's an extremely important subject.

  • Excisional Debridements: RACs will be focused particularly in this area once the program resumes.

  • Hot Spots #2: An in-depth look at vexing areas:

  • Colonoscopies & EGDs.

  • Coding and Billing for Outpatient Rehabilitation

  • Coding and Billing for Drugs and Biologicals

Valuable Offer

Your facility will have unlimited access to these online courses, including handouts and documents, for a full year with unlimited viewing! Encourage everyone in your organization to review these crucially important eCourses.


Order Now: Nine Courses, $999.95

For more information on RACUniversity and the special educational offer, click here.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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