'Medical necessity' joins RAC review requirements
To help shrink improper payments, the Centers for Medicare & Medicaid Services (CMS) has issued a list of medical necessity review audits required for its Medicare permanent recovery audit contractor (RAC) program.
The audits will include one type of durable medical equipment claims and 18 types of inpatient hospital claims. The agency has not yet announced which of the Part A hospital claims or which of the four regional RACs will conduct the audits.
The RACs will be mandated to post audits they will conduct and citations for related Medicare policy to their website prior to asking hospitals for additional documentation requests.
According to the American Heart Association, CMS said it expects RACs to post audits and issue additional documentation requests in the next two weeks.
The four RAC regions are each responsible for identifying overpayments and underpayments in a quarter of the U.S.
A copy of the CMS issues may be found here (under AHA News Now).
The audits will include one type of durable medical equipment claims and 18 types of inpatient hospital claims. The agency has not yet announced which of the Part A hospital claims or which of the four regional RACs will conduct the audits.
The RACs will be mandated to post audits they will conduct and citations for related Medicare policy to their website prior to asking hospitals for additional documentation requests.
According to the American Heart Association, CMS said it expects RACs to post audits and issue additional documentation requests in the next two weeks.
The four RAC regions are each responsible for identifying overpayments and underpayments in a quarter of the U.S.
A copy of the CMS issues may be found here (under AHA News Now).