You receive a RAC demand letter for repayment. But wait a minute before you pay up—you might want to take a close look to make sure your facility was really in the wrong. Karen Sagen, managed care leader at Bellin Health System in Green Bay, WI, who has worked in revenue cycle management for the past six years, has developed a step-by-step list of things to consider before pulling out your hospital’s checkbook.
RACs are looking at excisional debridement coding, and it’s no wonder. There are plenty of potential traps for coders reporting these inpatient procedures.
According to a July HCPro survey of approximately 500 healthcare providers, 56% have already received medical record requests and 40% have had money recouped by a RAC.
Medically unnecessary services and incorrectly coded items had the highest amounts of RAC overpayments collected in the demonstration project, according to CMS.
Recovery audit contractor (RAC) activity is picking up, but many healthcare providers are still waiting to see whether their preparations have paid off, according to a January survey of more than 400 healthcare providers conducted by MRB. Eighteen percent of survey respondents had received medical record requests (i.e., additional documentation requests) as of the time of the survey. Only 8% of providers received RAC denials.
