What are the target areas for the RAC auditors?
A. RAC audits are centered around a wide range of perceived provider errors initially uncovered by both Medicare fiscal intermediaries and the Office of Inspector General – as well as through contracted medical review relationships such as Comprehensive Error Rate Testing (CERT) organizations and the QIO Hospital Payment Monitoring Program (HPMP). RAC audit primary focus areas in the demonstration states included a diverse and wide ranging list of issues – Inpatient Rehabilitation Facility admissions, chest pain related one day stays, respiratory with ventilator coding, excisional debridement documentation, etc.. Based upon recent intermediary activity and OIG reports, we believe ER visits and the use of modifier 25 to be a major focus on the RAC audit radar going forward.
