Recovery Audit Contractors: Don't Double Dip with Hospital Visits

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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 premium article discusses Recovery Audit Contractor (RAC) scrutiny of hospital inpatient visit billing and percutaneous transluminal angioplasty (PTA) documentation. It is aimed at physicians, coders, billing staff, compliance teams, and practice managers who need to understand what types of Medicare claims are being reviewed, the general coverage and audit context, and where review activity is taking place.

Why This Topic Matters

The article helps readers recognize audit risks tied to hospital visit billing patterns and PTA claim support, which can affect Medicare compliance, payment recovery exposure, and documentation readiness.

Article Sections

  1. Background

    Introduces the RAC program and names the contractors discussed in the article. It also explains that the article focuses on selected review areas affecting Part B practices.

  2. Excessive Units of Hospital Visits

    Covers RAC review activity related to repeated hospital visit billing within the same day. The section also notes the affected geographic region and cites Medicare manual guidance and date-of-service review scope.

  3. PTA Under Scrutiny

    Summarizes RAC attention on documentation supporting PTA services. It also identifies the general coverage context, review timeframe, and region involved.

What You Will Learn

  • How RAC review activity can affect hospital visit billing patterns
  • What types of PTA claims may receive documentation review
  • Which Medicare contractor regions and states are involved
  • How the article frames audit risk and coverage oversight for Part B practices

Who Should Read This

  • Physicians
  • Medical coders
  • Billing staff
  • Compliance officers
  • Practice managers
  • Cardiology practices
  • Hospital-based providers

Codes Discussed

  • CPT: 99221
  • CPT: 99222
  • CPT: 99223
  • CPT: 99231
  • CPT: 99232
  • CPT: 99233

Code Ranges Discussed

  • CPT: 99221-99223
  • CPT: 99231-99233

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