In Audit
Apr 12th, 2019
Recovery Auditors have been busy. This year alone there are 23 topics under review and three more were just proposed. If you are coding/billing for any of the topics under review, this may be all the reason you need to conduct an internal review. Who Are They? Recovery Auditors, or Recover Audit Contractors (RACs), review ...
Knowing the various entities reviewing your medical records for accuracy is half the battle. Any entity that is expected to pay your claims has the right to review the documentation that (hopefully) supports the services being billed. To prepare for the inevitable, you are wise to familiarize yourself with which entities may be interested in ...
In Audit
Jun 8th, 2016
The Centers for Medicare & Medicaid Services (CMS) has made a number of changes to the Recovery Audit Program for 2016. One of those changes is the length of time a provider has to submit a Discussion Request to a recovery audit contractor (RAC) following an automated review. CMS is also establishing Additional Documentation Request ...
In Billing
Mar 11th, 2015
If a Medicare Administrative Contractor (MAC), or certain CMS review contractors (e.g., Comprehensive Error Rate Testing (CERT) contractors, and Recovery Audit Contractors (RACs)), request additional documentation for a particular claim, you have just 45 days to honor the request, or your claim will be denied. CMS Transmittal 567 specifies, “When requesting documentation for postpayment review, ...
In Audit
Dec 3rd, 2014
Effective December 29, 2014 Medicare administrative contractors can append Adjustment Reason Code RI “to all Part A (FISS) claim adjustments related to Recovery-Auditor post-payment review activities, including those resulting from appeal decisions that result in full or partial overturns of RA decisions,” according to the Centers for Medicare & Medicaid Services (CMS) Change Request (CR) ...