Compliance: Avoid These Missteps That Will Put You In The RAC Spotlight

Why This Topic Matters

Understanding current RAC focus areas helps practices assess audit risk, strengthen documentation, and review claim patterns before they become repayment issues. The article is relevant to organizations that bill observation services, hospital evaluation and management services, blepharoplasty-related procedures, or drug claims involving vial wastage.

Article Sections

1. Background on RAC review priorities

   Introduces the RAC program, the contractors involved, and the general purpose of the review topics discussed in the article.

2. Observation care for fewer than 8 hours

   Discusses audit attention on short observation stays and the related Medicare Part B billing area.

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

   Reviews contractor scrutiny of multiple evaluation and management services reported on the same date of service.

4. Blepharoplasty procedures

   Covers contractor review of eyelid surgery claims and the distinction between cosmetic and medically necessary services.

5. Billing for multi-use vials of Herceptin

   Describes review activity involving drug billing and discarded amounts associated with a cancer therapy product.