CMS requires that each RAC post issues approved for review on the RAC's Web site. Physicians and staff should frequently review the RAC Web site for their region to determine if CMS has approved any issues for review that may involve claims from the practice.
We have noted the following issues that may be related to claims submitted by family physicians, posted as of 10/13/09:
Where can I learn what issues the RAC is reviewing?
Jurisdiction A
Issues targeting DC, CT, MA, MD, ME, DE, NJ, NY, NH, PA, RI, VT (none as of 10/26/09, approved issues affect DME suppliers only )
Jurisdiction B
Issues & States Affected (as of 10/26/09)
- IV hydration therapy, CPT codes 90760 & 96360, when greater than 1 unit of service billed per date - Indiana, Michigan, Minnesota
- Once in a lifetime procedures billed more than once - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
- Code J2505, pegfilgrastim, limited to 1 unit of service per date - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
- Outpatient therapy services billed more than once per date of service (untimed codes only) - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
Jurisdiction C
Issues & States Affected (as of 10/13/09)
- Outpatient therapy services reported more than once per date (untimed codes only) - Alabama, Florida, Georgia, North Carolina, South Carolina
- IV hydration therapy CPT codes 90760 & 96360 when greater than 1 unit of service per date - Alabama, Florida, Georgia, South Carolina
- Once in a lifetime procedures billed more than once - Florida, Georgia, North Carolina, South Carolina
- Newborn services exceeding age parameters - Alabama, Florida, North Carolina, South Carolina
- Code J2505, pegfilgastrim, limited to 1 unit of service per date - Florida, Georgia, North Carolina, South Carolina
Jurisdiction D
Issues are for all Region D states (as of 10/26/09):
- Outpatient therapy services reported more than once per date (untimed codes only)
- IV hydration therapy CPT codes 90760 & 96360 when greater than 1 unit of service per date
- Once in a lifetime procedures billed more than once
- Newborn services exceeding age parameters
- Code J2505, pegfilgrastim, limited to 1 unit of service per date
Recovery Audit Contractors
RAC Scopes & Jurisdictions
Where can I learn what issues the RAC is reviewing?
Whose claims can be reviewed by the RAC?
Aren’t RAC’s focusing on hospital claims?
Do RAC’s review claims paid by Medicare Advantage Managed Care plans?
How far back can RAC’s look in reviewing claims?
Will RAC’s review claims for evaluation and management services?
RAC Review Criteria
How will RAC’s review claims for overpayments and underpayments?
RAC Recovery Requests
How can I identify a RAC recovery versus a request for refund from other sources?
If I disagree with an RAC’s overpayment findings, can I appeal?
Is there limitation on recovery of small overpayments found by the RAC?
Medical Record Review by the RAC
Must I allow the RAC to conduct an onsite review of my medical records?
Planning to Avoid RAC Issues
What should I do to protect my practice from RAC recovery efforts?
