DecisionHealth, DecisionHealth - 2013 Issue 11 (November)

Getting paid: Prepare for Region C RAC audit of major joint replacements

Make sure your provider’s documentation fully supports medical necessity for major joint replacements such as hip and knee arthroplasty, warn orthopedic coding experts. The reason: Recovery audit contractors will be performing complex medical reviews on your claims for these procedures. If the medical records don’t meet the criteria for medical necessity, you may find yourself forced to repay the money.

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