Eli's Rehab Report
Know the Billing Criteria RACs Will Be Referencing
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Question:
My question is, what, specifically, are the eight payment criteria we need to be following?
Washington Subscriber
Answer: There aren't literally eight criteria that RACs will be referencing when auditing therapy claims. The quote you're referring to was just an example this source made up to show how RACs work -- that they don't give you credit for meeting some payment criteria; you must meet it all, whatever that is. If there happens to be eight criteria, then you must meet all eight criteria.
The payment criteria RACs will be referencing include guidelines CMS has provided in the Medicare Claims Processing Manual (Pub 100-04) and the Medicare Benefit Policy Manual (Pub 100-02).
Choose the appropriate chapter in each manual based on your practice setting. You can access the manual at www.cms.hhs.gov./Manuals/IOM.
Reader Questions were answered by Rick Gawenda,PT, director of PM&R at Detroit Receiving Hospital and owner of Gawenda Seminars & Consulting.
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