tci Medicare Compliance & Reimbursement - 2005 Issue 21

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

... but CMS may examine medical necessity of the claims.Good news for hospitals: Medicare's new "bounty hunters" may not have your names on their hit list.The Recovery Audit Contractors have aroused apprehension because their payment comes in the form of a proportion of the funds they recoup from providers. But at an April 28 special Open Door Forum on the RACs, the Centers for Medicare and Medicaid Services revealed: that the RACs have chosen to focus on hospital inpatient claims for now. The contractors have the discretion to zero in on whatever area of Medicare they feel will...

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