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Thread: Rac

  1. #1
    Join Date
    Apr 2007

    Question Rac

    AAPC: Back to School
    Has anyone heard of any evaluation and management codes or any specialties they will NOT audit?

  2. #2
    Join Date
    Apr 2007
    St. Cloud, MN

    Default RAC information

    Through AHIMA - a subteam of the Clinical Terminology and Classification Practice Council has developed a toolkit to assist members in preparing for the for RAC audits through this weblink:


    The toolkit includes the following resources:
    • Program background
    • Overview of audit process
    • Preparation checklist
    • Hierarchy of Authority
    • Sample Policy and Procedure
    • Sample RAC Coordinator Job description
    • Education materials
    • Sample Appeal Letters
    • Appeal Submission Checklist
    • Resource links

    If you are not an AHIMA member, perhaps someone else in your office might be to access this great information.

    Cindy Norling, CPC-H, CCS-P
    St. Cloud Local AAPC Chapter President

    “The best way out is always through.”- Robert Frost (1874-1963), poet

  3. #3
    Join Date
    Apr 2007
    North Carolina



    Q: Will the Recovery Audit Contractors (RAC) review evaluation and management (E&M) services on physician claims under Part B?

    A: Yes, the review of all evaluation and management (E & M) services will be allowed under the RAC program. The review of duplicate claims or E & M services that should be included in a global surgery were available for review during the RAC demonstration and will continue to be available for review. The review of the level of the visit of some E & M services was not included in the RAC demonstration. CMS will work closely with the American Medical Association and the physician community prior to any reviews being completed regarding the level of the visit and will provide notice to the physician community before the RACs are allowed to begin reviews of evaluation and management (E & M) services and the level of the visit


    Look under "frequently asked questions"

  4. Default RAC and E/M services

    The RAC's will be allowed to audit E/M services, although they were out of the scope of the demo projects.

    The RAC contractors will be paid about 10% of the money they recover. If it were me, I wouldn't be looking at whether it should be a 99213 or a 99214. From an E/M perspective, I think the highest level in each category of code would be a risk. Also, nurse visits billed with another service, or a low level E/M billed with every procedure. (a podiatrist who always bills the lowest level nursing home service with nail care, for example.)

    The RACs will be selecting services to audit based on paid claims data, and based on analyzing aberrant data. Here's an article about the topic:


    Betsy Nicoletti, M.S., CPC

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