CMS has approved medical necessity review audits by recovery audit contractors, according to a report by AHA News Now.
The RAC audits — the first to examine medical necessity — will include 18 types of inpatient claims and one type of durable medical equipment claim.
RACs are expected to post which audits they will conduct on their websites in the next two weeks, and Additional Documentation Requests are expected to be issued after that.
The report noted that reviews of medical necessity were problematic during the RAC demonstration project, due largely to concerns auditors lack adequate clinical and Medicare knowledge.
Read the AHA News Now report on RAC medical necessity review audits.
Read more coverage on RACs.
- Federal Report Urges CMS to Address Overpayment Issues Identified by RACs
- OIG: RAC Program Lacks Sufficient Fraud Training
The RAC audits — the first to examine medical necessity — will include 18 types of inpatient claims and one type of durable medical equipment claim.
RACs are expected to post which audits they will conduct on their websites in the next two weeks, and Additional Documentation Requests are expected to be issued after that.
The report noted that reviews of medical necessity were problematic during the RAC demonstration project, due largely to concerns auditors lack adequate clinical and Medicare knowledge.
Read the AHA News Now report on RAC medical necessity review audits.
Read more coverage on RACs.
- Federal Report Urges CMS to Address Overpayment Issues Identified by RACs
- OIG: RAC Program Lacks Sufficient Fraud Training