RAC issue for IRFs has moved from being proposed to being approved.
The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex Medical Review for (inpatient rehabilitation facilities) IRFs. The issue: 0A024-Inpatient Rehabilitation Facility (IRF) Stays: Meeting Requirements in the proposed Recovery Audit Contractors (RAC) Topics list on the CMS website. On Sept. 11, 2018 that issue was moved to the Approved Topics list and IRFs can now expect to receive Additional Document Requests (ADRs) from the RAC.
Who is Affected?
The approved review will affect all regions and all states so ultimately every IRF will be open for review.
How Will We Know When Our Region Begins Audits?
The table below, copied from the CMS Website, lists the RAC Regions with links to each RACs website.
|
Region |
States |
Websites |
|
Phone Number |
|
Region 1 Performant Recovery, Inc. |
CT, IN, KY, MA, ME, MI, NH, NY, OH, RI, and VT |
1-866-201-0580 |
||
|
Region 2 Cotiviti, LLC |
AR, CO, IA, IL, KS, LA, MO, MN, MS, NE, NM, OK, TX, and WI |
1-866-360-2507 |
||
|
Region 3 Cotiviti LLC |
AL, FL, GA, NC, SC, TN, VA, WV, Puerto Rico and U.S. Virgin Islands |
1-866-360-2507 |
||
|
Region 4 HMS Federal Solutions |
AK, AZ, CA, DC, DE, HI, ID, MD, MT, ND, NJ, NV, OR, PA, SD, UT, WA, WY, Guam, American Samoa and Northern Marianas |
Part A: 1-877-350-7992 Part B: 1-877-350-7993 |
As of Sept. 18, 2018, none of the RACs have yet posted details on these reviews on their website. We’ll be checking regularly, however, and will update readers when the RACs post information.
So, What Now?
The reviews would impact RAC Regions 1-4 in all states and will likely include a review of how well the IRF meets the Jan.1, 2010 clarifications for reasonable and necessary care in an IRF – the same areas that have been consistently reviewed by Medicare Administrative Contractors (MACs) in Probe & Educate reviews, by Special Medical Review Contractors (SMRC), and in the current Targeted Probe and Education program (TPE). IRFs should watch the websites and our updates for updates to the issues and details of these audits.
The Bottom Line
Clear, complete and timely documentation continues to be the IRFs best defense for ongoing audits. Additionally, a clear process for responding to document requests to assure that the required documentation is submitted in a timely manner will aid the IRF in successful audit performance.
With little fanfare, last week the Centers for Medicare & Medicaid Services (CMS) announced another Review Choice Demonstration Project. Joining the ongoing Review Choice Demonstration
Last week I wrote about the ongoing issue of Medicare Advantage (MA) denials related to appropriate transfer to a skilled nursing facility (SNF) and the
Please log in to your account to comment on this article.
Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Practical solutions for CDM departments to protect your hospital’s revenue.
This webcast teaches hospitals how to comply with CMS price transparency rules and compare their rates with peer hospitals. It covers creating a compliant machine-readable file, comparing negotiated rates, and improving pricing decisions.
The No Surprises Act (NSA) presents a challenge for hospitals and providers who must provide Good Faith Estimates (GFEs) for all schedulable services for self-pay and uninsured patients. Compliance is necessary, but few hospitals have been able to fully comply with the requirements despite being a year into the NSA. This webcast provides an overview of the NSA/GFE policy, its impact, and a step-by-step process to adhere to the requirements and avoid non-compliance penalties.
This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.
Set yourself up for financial and compliance success with expert guidance that breaks down the impactful changes including MS-DRG methodology, surgical hierarchy updates, and many new technology add-on payments (NTAPs). Identify areas of potential challenge ahead of time and master solutions for all 2024 Proposed IPPS changes.
Do you struggle with selecting and appending the correct modifier for your medical claims? Join our must-attend webinar, “Mastering Modifier Usage: Preventing Denials and Ensuring Compliance” to reduce claim denials and improve your reimbursement rates.
Kay Piper reviews the guidance and updates coders and CDISs on important information in the AHA’s fourth quarter 2023 ICD-10-CM/PCS Quarterly Coding Clinic in an easy to access on-demand webcast.
Copyright © 2022 RACmonitor. Powered by MedLearn Media.
