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 otolaryngologists:
Untimed Codes - CPT Codes (excluding modifiers KX, and 59) where the procedure is not defined by a specific timeframe (untimed codes), the provider should enter a one (1) in the units billed column per date of service.
Example: 92506 - Evaluation of speech, language, voice, communication, and/or auditory processing
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: 31360 - Laryngectomy; total, without radical neck dissection
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: 42820- Tonsillectomy and adenoidectomy; under age 12
Click here for a sample of the RAC letter.
ARM Yourself TODAY:
- Compare your E&M coding patterns against other otolaryngologists 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. Attend the Friday Course: Mastering Business Administration Without an MBA and the Saturday Course: Proven Coding Solutions for Otolaryngology.
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.
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