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Medicare Learning Network Articles related to the Recovery Audit Contractor (RAC) program

CMS recently released two special edition Medicare Learning Network Articles related to the Recovery Audit Contractor (RAC) program. The documents are intended to share information and data as they related to the initial RAC demonstration program.

The first document, found at http://www.cms.gov/MLNMattersArticles/downloads/SE1027.pdf
outlines the data points and collected overpayments associated with medical necessity reviews. It is important to note that the data shared in the article does not include the number of dollars that may have been overturned upon appeal. Of the 17 outlined medical necessity reviews outlined in the article 8 have been approved by CMS to become part of the Permanent RAC program in California.

The second document (http://www.cms.gov/MLNMattersArticles/downloads/SE1028.pdf) outlines RAC reviews related to improper DRG payments. The article highlights the importance of ensuring that the coding on the bill matches the coding in the medical record. Hospitals should re-iterate to all levels the importance of documentation of coding in the medical record.

If you have any questions, please contact me at (916) 552 7669 or mabsher@calhospital.org.

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