RACs Won’t Review Any Hospital Claims for Inpatient vs. Outpatient Status in 2015, AIS Newsletter Learns
Washington, DC (PRWEB) January 15, 2015 -- 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.”
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About Report on Medicare Compliance
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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.
Jill Brown, Executive Editor, Atlantic Information Services, http://www.aishealth.com, +1 (202) 775-9008 Ext: 3058, [email protected]
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