Recovery Audit Contractors: This RAC Targets 'Excessive' Hospital Visits

Why This Topic Matters

Providers and billing teams need to know when audit activity is targeting common hospital visit billing patterns or angioplasty claims so they can assess documentation, coverage, and claims exposure under Medicare review programs.

Article Sections

1. Background: RAC program and contractor review areas

   An overview of the RAC program structure and the contractors identified in the article. It also introduces the general subject matter of the current review areas affecting Part B practices.

2. Excessive Units of Hospital Visits

   Discussion of a hospital visit review initiative focused on repeated same-day inpatient hospital care billing patterns. The section also notes the relevant Medicare manual citation and the geographic scope of the review.

3. PTA Under Scrutiny

   Discussion of a review initiative involving percutaneous transluminal angioplasty claims and documentation review. The section references national coverage guidance, contractor review timing, and the affected region.