IN OTHER NEWS ...• Wondering how the new Recovery Audit Contractors plan to review -- and possibly deny -- your claims from afar?

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers several Medicare administration updates, including how a recovery audit contractor is using clinical guidelines to review claims, a CMS transmittal on RAC communications and review process topics, and a separate CMS transmittal affecting National Supplier Clearinghouse correspondence and NPI handling. It is relevant for billing, compliance, reimbursement, and Medicare administrative staff who track contractor activity and operational changes.

Why This Topic Matters

These updates affect how providers and suppliers interact with Medicare contractors, prepare for claim review activity, and respond to CMS administrative correspondence. It helps readers monitor policy and process changes that may influence compliance workflows.

Article Sections

  1. RAC review guidance and clinical guideline software

    Discusses a recovery audit contractor and its use of clinical guideline content and software to support Medicare claims review. Also references broad topic areas covered by the guideline product.

  2. CMS Transmittal 148: RAC communications and process overview

    Summarizes a CMS transmittal addressing communication with RACs, points of contact, and an overview of the RAC process. It also notes that the transmittal discusses exclusion and suppression topics.

  3. CMS Transmittal 451 (CR 6314): NPI on NSC correspondence

    Covers a CMS update directing the National Supplier Clearinghouse to include NPI information in supplier correspondence and to validate NPIs beginning in July.

What You Will Learn

  • How CMS administrative updates relate to recovery audit contractor activity
  • What types of RAC operational topics are addressed in the cited transmittal
  • How NPI handling is changing in National Supplier Clearinghouse correspondence
  • Which broad Medicare administrative processes are affected by the cited CMS notices

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance professionals
  • Revenue cycle managers
  • Medicare providers
  • Supplier enrollment staff

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