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  1. #1
    Question Rac
    Exam Training Packages
    Has anyone heard of any evaluation and management codes or any specialties they will NOT audit?

  2. #2
    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
    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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