tci Outpatient Facility Coding Alert - 2013 Issue 5

Therapy Services: Get Ready for RAC Manual Reviews for Therapy Claims Over $3700

Experts concerned that RACs get paid extra for every claim they deny. If you thought your therapy services went under enough scrutiny from Recovery Audit Contractors (RACs), get ready for one more item on the list. CMS has announced that for all outpatient therapy claims surpassing the $3,700 threshold, as of April 1, 2013, RACs will be conducting the manual medical reviews — not your Medicare Administrative Contractor (MAC). Understand the Pros and Cons RACs are paid on a contingency fee, which means they get a percentage of the dollars for denied claims. “This could have a...

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