In Audit
Nov 13th, 2014
Recovery audit contractors (RACs) have recouped millions of dollars for excisional debridements that weren’t really excisional, or that weren’t fully documented to support the coding reported. In CPT® terms, think of the skin debridement codes in the 10000 section as excisional, and the debridement codes found in the 90000 section as non-excisional. As explained in ...
[Facility] Stand up to scrutiny by ensuring key components are included in patient documentation. By Heather Greene, MBA, RHIA, CPC, CPMA The Centers for Medicare & Medicaid Services (CMS) will conduct prepayment patient status probe reviews for dates of admission between October 1, 2013 and March 31, 2015 using a “probe and educate” format. In ...
As prospective recovery audit contractors (RAC) line up to be selected for the next phase of the program, changes to the Centers for Medicare & Medicaid Services’s  (CMS’s) Recovery Audit Program continue with a May 7 directive to recovery auditors that the last day they may send claim adjustment files to Medicare administrative contractors (MACs) is ...
In Audit
Mar 13th, 2014
CMS seeks new contractors; looks to clear appeals, improve program CMS’s agreements with recovery audit contractors (RACs) to administer the recovery audit program are winding down. As of March 1, the current RACs may no longer send additional documentation requests (ADRs) to providers. Recovery auditors may conduct automated reviews through June 1, and may complete ...
Know where auditors are focusing and build a solid defense. By Elin Baklid-Kunz, MBA, CHC, CPC, CCS The Department of Health & Human Services has an agenda—to put measures in place that both increase quality of care and decrease government spending, due mainly to healthcare fraud and abuse. Not one of us is exempt from ...