THE RACS ARE HERE

ITHE RACS ARE HERE! Are you ready?

The RACs (Recovery Audit Contractors) are CMS’ hired guns to identify and recoup improper Medicare payments. They are paid on a contingency basis – there’s an incentive for them to “find” mistakes.

What are they looking for? Fortunately, CMS has to approve audit issues for the RACs.

Of particular interest to general surgeons:

Blood Transfusions - CPT codes 36430, 36440, 36450, and 36455 (excluding claims with any modifiers) should be billed as one (1) per session, regardless of the number of units transfused on that date of service.

Bronchoscopy Services - CPT Codes 31625, 31628 and 31629 should be billed with a maximum number of units of one (1) per patient per date of service (excluding claims with modifier 59) should only be reported with one unit per date of service.

Once in a lifetime procedures - By virtue of the description of the CPT code, these codes can be performed only once per patient lifetime.

Example: 47600 - Cholecystectomy

Pediatric codes exceeding age parameters - Newborn/Pediatric CPT codes being applied/billed for patients which exceed the age limit defined by the CPT code.

Example: 49495 - Repair, initial inguinal hernia, full term infant under age 6 months

Click links below for a sample of the RAC letter:

Connolly Consulting Associates, Inc
CGI

ARM Yourself TODAY:

• Compare your E&M coding patterns against other general surgeons state and national figures using CMS’ most recently published claims database by using KZA’s E&M Profile Analyzer*
  
  
• Conduct an internal coding review to ensure that Medicare guidelines have been followed . How? Use the results of the E&M Analyzer to determine which physicians are outliers to state and national norms. Use this data to “dig deeper” and take a close look at coding and documentation.
  
  
• Provide refresher training to your billers and coders.

Below are the RACs and states that have approved issues at this time:

Connolly Consulting Associates, Inc. is the RAC contractor Alabama, Florida, Georgia, and South Carolina. Click here for the complete list of CMS approved issues for Connolly.

CGI is the RAC contractor for Indiana, Michigan and Minnesota. Click here for the complete list of CMS approved issues for CGI.

Health Data Insights is the RAC Contractor for Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming. Click here for the complete list of CMS approved issues for Health Data Insights.

For more information visit www.karenzupko.com or call (312) 642-5616.