RAC increases efforts, targeting outpatient hospital, physician claims

Why This Topic Matters

It helps readers identify which outpatient claim categories were being targeted by RACs and understand the compliance pressure affecting hospital outpatient and physician billing workflows.

Article Sections

1. RAC audit expansion and regional targets

   Introduces the broader increase in Recovery Audit Contractor activity and identifies the regional focus of the audit targets. It also notes the kinds of outpatient claim areas attracting attention.

2. Medically unlikely edits and outpatient billing concerns

   Discusses the role of medically unlikely edits in outpatient hospital claims and the general challenge these edits create for billing compliance. It also references related outpatient audit concerns.

3. Specific outpatient services under review

   Summarizes the outpatient service categories highlighted in the article, including imaging, drug administration, and demonstration or evaluation services. The section also distinguishes when certain issues affect hospital outpatient claims versus physician claims.

4. Online resources and editorial note

   Lists referenced web resources and includes an editorial note about related RAC materials and updates. This closing material provides source references rather than substantive coding guidance.