HOSPITALS: E/M Visit Levels Are Safe From RAC Scrutiny

Why This Topic Matters

Hospitals and other providers need to know which claim types are likely to be reviewed and what kinds of billing issues may draw audit attention. Understanding the general scope of RAC activity helps organizations prepare for post-payment scrutiny and compliance review.

Article Sections

1. RAC audit focus and Medicare claim review

   Discusses the early focus of Recovery Audit Contractors and the types of Medicare claims they may examine. It also notes the broader audit environment for hospitals and physicians.

2. Evaluation and management review and claim necessity

   Covers the article’s discussion of evaluation and management visits in the context of hospital claims review. The section addresses general questions about medical necessity and bundling within Medicare claim review.

3. No fraud and abuse checks yet

   Summarizes the article’s discussion of the scope and limits of the contractors’ review activity. It includes general references to post-payment review and Medicare administrative processes.