tci Outpatient Facility Coding Alert - 2017 Issue 10

Audits: RACs Flag Shoulder Debridement, Complex Cataract Procedures

Is a Recovery Audit Contractor data-mining your claims? Here's how to tell. We hear about Recovery Audit Contractors (RACs) all the time, but their origin, purpose, and implications for your coding and billing can be confusing. Here's what you need to know about RACs so that you can defend your ambulatory surgery center or hospital outpatient department from a potential audit. RACs are independent contractors that data-mine Medicare claims, review them for errors, and collect contingency fees based on the amounts they recover. Because of how they are paid, RACs are incentivized to go after coding and billing errors...

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