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RACs Begin Medical Necessity Reviews

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  • In Audit
  • August 16, 2010
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The Centers for Medicare & Medicaid Services’ (CMS) New Issue Review Board recently approved the first medical necessity review audits for Medicare’s permanent recovery audit contractor (RAC) program, reports AHA News. The newly approved audits include 18 types of inpatient hospital claims and one type of durable medical equipment (DME) claim. The particular issues and the first of the four regional RACs that will conduct medical necessity reviews for them was just recently announced.
Region B RAC, CGI Federal posted on its website, Aug. 6, its list of approved issues for medical necessity review. Nine of the 18 issues are revisions of existing diagnosis-related group (DRG) validation issues, according to HCPro.
Before issuing additional documentation requests (ADRs) to hospitals for these reviews, each RAC must post on its website the particular audits it will conduct, including citations for the related Medicare policy. CMS expects the remaining RACs to post the new audits and begin issuing ADRs within the next two weeks.

No Responses to “RACs Begin Medical Necessity Reviews”

  1. Asad Ali Rizvi says:

    In the second paragraph above, you mentioned:
    “Region B RAC, Connolly Healthcare posted on its website, Aug. 12 …..”
    Probably, it was a typo. Just wanted to clarify that Region B comes under CGI Federal.
    Connolly Healthcare monitors Region C.
    Thank you.