Compliance: Look Out for These New RAC Audit Issues

Why This Topic Matters

RAC review topics can affect claim payment, retrospective audits, and compliance risk for practices that bill common outpatient and hospital services. Understanding the scope of these audit areas helps organizations identify which services, dates of service, and documentation categories may warrant closer internal review.

Article Sections

1. Background on RAC audit focus

   Introduces the recovery audit contractor program and identifies the contractors referenced in the article. Summarizes the general purpose of the newly approved review areas.

2. Observation care for fewer than 8 hours

   Covers the audit focus related to short observation stays and related Part B claim review activity. Notes the geographic scope and time period affected.

3. Billing more than one E/M code per day

   Describes the review area involving multiple evaluation and management services on the same date of service. Explains the audit scope and the affected states.

4. Blepharoplasty procedures

   Summarizes the RAC review activity for eyelid surgery claims and the emphasis on medical necessity documentation. Notes that multiple contractors were involved in the review issue.

5. Billing for multi-use vials of Herceptin

   Discusses claim review for drug vial billing practices involving a cancer therapy product and related modifier use concerns. Indicates that the issue was being reviewed by several contractors.