RACs Won’t Review Any Hospital Claims for Inpatient vs. Outpatient Status in 2015, AIS Newsletter Learns

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For 2015, the incumbent RACs will do automated reviews, according to reporting in the Jan. 12 issue of Atlantic Information Services’ Report on Medicare Compliance.

Despite having their contracts extended through the end of the year, the four existing recovery audit contractors (RACs) will not review inpatient admissions in terms of whether patients were appropriately admitted or should have been treated as outpatients, a CMS spokesman tells Atlantic Information Services, Inc.’s (AIS) Report on Medicare Compliance (RMC) in its Jan. 12 issue. Inpatient hospital patient status reviews will presumably resume next year, when the second round of RAC contracts takes effect.

For 2015, the incumbent RACs will do automated reviews, though some will be complex, involving the review of medical records submitted by hospitals, RMC has learned. They are also conducting limited reviews of spinal fusion, cosmetic surgery, outpatient therapy, durable medical equipment and other risk areas approved by the agency. The four RACs will continue to work on appeals and reconciliations through April 2017, says Emily Evans, a partner in Obsidian Research in Nashville.

When the new RAC contracts are awarded next year, patient status and inpatient rehabilitation will be probable targets, Atlanta-based attorney Sarah Kay Wheeler of King & Spalding tells RMC, citing “a lot of activity prior to the expiration of contracts in inpatient rehabilitation.”

Visit http://aishealth.com/archive/rmc011215-01 to read the article in its entirety.

About Report on Medicare Compliance
The industry's #1 source of timely news and proven strategies on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers, the award-winning Report on Medicare Compliance identifies and provides valuable guidance on dozens of high-risk billing and documentation problems and foreshadows the next moves of federal enforcers and their armies of RAC, ZPIC and MAC auditors. “The best information there is for hospital compliance officers,” the 8-page weekly newsletter includes insights and strategies not available anywhere else.

Since 1992, Report on Medicare Compliance has been written by Nina Youngstrom, who has a reputation for being one of the most knowledgeable journalists and incisive writers in the field. With excellent Contact s at the IG's office and at CMS, and strong relationships among industry experts and compliance officers, each issue of Report on Medicare Compliance contains exclusive, inside news. Visit http://aishealth.com/marketplace/report-medicare-compliance for more information.

About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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