RAC FOR REGION D PUBLISHES APPROVED AUDIT ISSUES

The Recovery Audit Contractor (“RAC”) for region D, HealthDataInsights, Inc. recently published its RAC website, and published its first list of approved RAC audit issues for complex coding reviews.

Pursuant to the recently-published CMS RAC Review Phase In Strategy, complex reviews regarding DRG validation and coding errors were scheduled to begin in August or September 2009. Consistent with this time frame, this month, the RACs for Region C (Connolly Consulting, Inc.) and Region D published nearly-identical lists of issues that CMS has approved for complex coding review auditing. This means that Medicare providers and suppliers in Regions C and D (comprising the western, southern and southeastern states) will soon begin to receive requests for medical records from the RACs for review of the identified issues.

Approved issues include:
• Blood transfusions (excessive units)
• Untimed codes (excessive units)
• IV hydration therapy (excessive units)
• Bronchoscopy services (excessive units)
• Once-in-a-lifetime procedures • Pediatric codes exceeding age parameters • Injections – Pegfilgrastim, Neulasta
Notably, since the lists of approved issues is nearly identical for both Regions C and D, Medicare providers and suppliers in all regions are well advised to pay particular attention to these types of claims, as it is likely the RACs in Regions A and B may follow the lead of Regions C and D and select these same issues for review.

For more information regarding Recovery Audit Contractors and/or any other type of Medicare or payor audit, please email Abby Pendleton, Esq. or Jessica L. Gustafson, Esq., or call us at (248) 996-8510. We also invite you to visit the RAC page of the HLP website.