RAC Audit Update
We have been waiting all summer for something to happen with the RAC audits. Finally, as of August 4th, it looks like the action may beginning to break. Connolly Consulting, the Recovery Audit Contractor for Region C, has just released a list of seven issues that have been approved by CMS for its initial automated reviews. These seven "issues" are:
1. Blood Transfusions.
2. Untimed Codes.
3. IV Hydration Therapy.
4. Bronchoscopy Services.
5. Once in a lifetime procedures.
6. Pediatric codes exceeding age parameters.
7. J2505: Injection, Pegfilgrastim, 6 mg.
While is it not clear whether these issues are specific only to Connolly and Region C or whether the other RAC auditors will be using this same list to begin their automated reviews, health care providers would be wise to take this list and begin to run some internal data to assess accuracy in coding and billing as it relates to these topics. Problems should be corrected immediately and over-payments refunded.
For those located in Region B (including Michigan), it is probably a good idea to get in the habit of checking the CGI website on a regular basis going forward to make sure that you have as much advance notice as possible, in the event CGI posts its own list of approved issues for automated review.
