AHA Coding Clinic® for HCPCS - 2009 Quarter 3
Coming to your Facility Soon: RAC Attack
The first round of Recovery Audit Contractor (RAC) reviews have begun. Unfortunately, we can’t stop the audits from taking place, so we might as well make preparations for the impending reviews. Many facilities will be hit in the first round but even if you’re not in the first round brace up because your turn is surely coming. Hopefully, you are conducting internal analyses of your facility’s compliance with Medicare rules for the submission of claims. Just to provide a prospective of the types of issues targeted for review by the RACs, we would like to share...
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Article Overview
This piece is a practical overview for facilities, billing teams, and compliance staff preparing for early Recovery Audit Contractor activity. It explains the regional RAC structure, identifies the broad categories of claim and coding issues under review, and notes why internal Medicare compliance checks matter before audits begin.
Why This Topic Matters
The article helps organizations understand the kinds of claims and documentation areas RAC reviewers are focusing on so they can assess internal compliance readiness. It is relevant to reimbursement, coding compliance, and audit preparation teams working with Medicare claims.
Article Sections
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RAC regions and contractor websites
Introduces the regional structure of the Recovery Audit Contractor program and lists the contractors involved. It also provides website information for each region.
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Types of issues targeted for review
Summarizes the broad categories of billing and coding concerns that RAC reviewers are expected to examine. The discussion focuses on general audit themes rather than detailed determinations.
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Issues approved by CMS for review
Outlines the first set of issue categories posted for audit review across the regions. The section groups the topics by type of service or coding circumstance and notes regional availability.
What You Will Learn
- How the RAC program is organized by region
- What broad claim-review themes were prioritized early in the RAC rollout
- Which general categories of billing and coding issues were posted for review
- How the article frames audit preparation for Medicare compliance teams
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle teams
- Facility administrators
- Audit preparation staff
Codes Discussed
Modifiers Discussed
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