Recovery Audit Contractors: Correct These Issues To Stay Out Of The RACs' Field Of Vision

Why This Topic Matters

RAC findings can lead to repayment demands and signal recurring claim risk areas for physician practices. Understanding the kinds of issues discussed in this article can help revenue cycle teams recognize where claims are vulnerable to review.

Article Sections

1. RAC Issue 1: Place of Service Coding

   Discusses one high-risk claim reporting area involving place of service reporting and how CMS and RACs identified related billing mismatches. The section also references a related Medicare Learning Network article.

2. RAC Issue 2: Duplicate Billing

   Covers duplicate claim payment concerns, including how RACs and CMS identified repeated payments and the broader reimbursement impact. The section points readers to related Medicare Learning Network guidance.

3. RAC Issue 3: E/M Codes With Pulmonary Diagnostic Services

   Addresses claims involving evaluation and management reporting alongside pulmonary diagnostic services and references CMS guidance on same-day service reporting. The section focuses on the type of coding scenario RACs reviewed.

4. RAC Issue 4: Misuse of Add-on Codes

   Reviews add-on coding as a recurring audit concern and describes the general payment vulnerability when supporting claim elements are missing. The section cites CMS material on this issue.

5. RAC Issue 5: Inappropriate Co-Surgeon Billing

   Discusses co-surgeon billing as another audit target and explains that the section concerns how shared-surgery claims were reviewed by RACs. It also references related CMS guidance.