decisionhealth Newsletters, Part B News - 2009 Issue 8 (August)
7 CMS-approved RAC targets
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Article Overview
This article summarizes seven CMS-approved RAC review targets reported by Connolly Healthcare and explains the broad categories of claims being watched for physicians and outpatient hospitals in South Carolina. It is relevant to coding, billing, and compliance staff who want to understand the kinds of services and claim patterns that may draw RAC attention, including issues tied to unit counts, time-based reporting, age-based applicability, and other claim-level screening topics.
Why This Topic Matters
The article helps practices recognize the general audit themes that can trigger RAC review so they can evaluate internal billing patterns and monitor whether similar review topics may later appear on their own RAC site.
Article Sections
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CMS-approved RAC targets
Introduces the approved review topics and explains that the examples described are currently focused on a specific state and provider setting. It also frames the content as a preview of claim categories that may be relevant elsewhere later.
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Claim categories under review
Summarizes the broad types of claims and billing patterns described in the article, including transfusion-related services, untimed services, hydration therapy, bronchoscopy, once-in-a-lifetime procedures, pediatric age limits, and a drug injection issue.
What You Will Learn
- What kinds of RAC review topics are being monitored
- How the article groups claim issues into broad billing categories
- Which provider settings and geographic focus are mentioned
- Why unit counts, timing, and age applicability can matter in audit review
Who Should Read This
- Physician coders
- Hospital outpatient coders
- Billing staff
- Compliance teams
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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