RACs Can Request Claims Not on Approved List

If you are under the impression that recovery audit contractors can only audit claims that are on CMS' approved list, think again, says Paul Spencer, a compliance officer for Fi-Med Management, physician practice financial management company based in Wauwatosa, Wis.

After hearing RACs were requesting claims not on the approved list, Mr. Spencer says he asked a CMS official and confirmed that a provider is obligated to fulfill any request that a RAC makes, even if it is not on the list.  

Mr. Spencer says in these cases, the RAC may be conducting a probe to determine whether a particular type of claim should be put on the approved list.

Citing an example of a RAC making such request, he says the Region D RAC made additional documentation requests for 120 claims for E/M services submitted by a practice in Nevada. Parenthetically, it was the first time Mr. Spencer heard of a practice undergoing a complex review.

Find out more about Fi-Med Management.

Read more coverage of RACs:

- RACs Starting to Audit Physicians' E/M Codes

- 10 Tips on Improving RAC Readiness From Kaiser's RAC Expert

- 6 RAC Issues For Hospitals in 2011

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