Medical Coding Journal

CGI Updates “New Issues”

Three Automated Denial Issues Added to RAC's Site The RAC for Region B, CGI Federal, has just this afternoon posted three new issues to their "new Issues" page. The three "new issues" approved as of 9/30/2009 are: Neulasta (billed more than once per patient per date of service) Once in a Lifetime Procedures ...

Feel the HEAT

...and you thought the RACs were HOT? The HEAT are even hotter. No, we're not talking about the Miami HEAT basketball squad. We're talking about the fed's newest and perhaps most wide-reaching "tool" for fighting fraud and abuse in Medicare and Medicaid program reimbursements: HEAT, or the Health Care Fraud Prevention ...

New Approved Issues Appear

All Four RACs Now Approved for Audits The last of the four RACs has now posted approved issues on their websites. What this means is that all 50 states are now eligible to begin receiving RAC denials. DCS just posted their first approved issues. Find Approved Issues listed HERE. Watch your Remittance Advice ...

First RAC Audit Issues Appear

Connolly Gets Audit Issues Approved CMS has evidently approved the first issues for RAC audits by Connolly Healthcare. Seven specific issues are now listed on the Connolly Healthcare RAC website. Connolly is responsible for Region C, but the issues have so far only been approved for the state of South Carolina. States ...

President Obama & Dr. Gawande

With all the activity lately on his desire "fix" health care nationwide, ever wonder what President Obama has been reading, of late? There were some recent articles about just that, and if you haven't seen these articles, we highly recommend them: This article from Dr. Atul Gawande of Harvard Medical School, ...

“Reach-Thru Denials” Not Automatic

A question often asked by hospitals during CMS' Outreach Sessions in various states concerns what is often called "reach-thru effect. This refers to what happens when Part A claims filed by hospitals are subsequently denied by a RAC for lack of medical necessity, due to either a lack of (physician ...

RAC Demand Letter Sample

CMS has issued a sample demand letter for providers, as an example of what to expect from the RACs. They intend this to be only the first sample letter in a series from CMS. Download a copy HERE. HealthDataInsights indicated during a May 28 Region D training session that CMS ...

Connolly Chooses Milliman

The RAC for Region C, Connolly Healthcare, has evidently decided to use Milliman guidelines as their preferred tool for judging status designations in Medicare facility-based claims. We received an email from a client facility, quoting an email from Christine Castelli, Principal, Healthcare Division, Connolly Consulting, dated May 25, stating the ...

CMS Contacts List and RAC Websites

If you have any questions or problems with the RAC program, CMS asks that you email them to this address: rac@cms.hhs.gov Alternatively, CMS has given out and listed the names and contact numbers for the four RAC Project Officers - each is responsible for a specific RAC Region - and even ...

Free RAC Appeals Process Webinar

eduTrax is offering a free webinar for all providers on the RAC Appeals Process. The webinar is scheduled for Tuesday, May 19, 2009, at 1:30pm ET (12:30pm CT / 11:30am MT / 10:30am PT) and will last for 60 minutes. Click HERE to Register for FREE Who handles the RAC requests in ...