Connolly Healthcare, Region C RAC, posted over 40 new issues, all for Complex Reviews, most for Inpatient Hospitals, during the final week of December, 2009. Happy New Year! The total number of issues now approved for Connolly’s review is over 75. Most of those issues will review MS-DRG coding and DRG Validation, but those all include the following phrase in their title:
At this time, Medical Necessity excluded from review.
Of course, this could change at any time now, since CMS plans to allow Medical Necessity to be reviewed, beginning in calendar 2010. (See CMS RAC Review Phase-in Strategy)
Non-User Friendly Lists
However, as we discovered in this past quarter, since the RACs began posting new issues, as they are required to do by CMS, we noticed that the WAY in which they post the new issues is not consistent, from RAC to RAC. What’s worse, there seems to be no effort on the part of the RAC to make that information easy to sort, copy, or deal with in any useful form. That is, you can’t sort the list, you can’t make a decent copy of it, you can’t even see all the data you might like to know on each issue.
Changes Made Without Notice
The worst part, however, is the way that the RACs do their postings: willy-nilly. In other words, they just throw the posts up there. There is no notice sent or made about a new post being added and/or changed. When new issues are added, there is also no effort made to group similar issues together. For example, on the Connolly list, some of the DRG Validation issues involve all three of an MS-DRG triplet (a triplet is an MS-DRG “group,” if you will, a set of three MS-DRGs that represent all three severity levels assigned by CMS to that diagnosis — e.g., Pneumonia is assigned a triplet, 193/194/195, representing Pnuemonia with an MCC, with just a CC, or without MCC or CC). This is not huge, but it certainly makes it difficult to work with the list.
Needless Complexity
For example, we know of one hospital in Region C that received a single letter requesting 24 medical records, one for each of 24 different MS-DRGs. The MS-DRGs were simply listed by number, with no descriptions. For a coding department, this is not a huge problem. However, for a RAC Team, it is an issue. Why? Because the letter probably has to travel thru several hands to get to the Coding department, who then have to look up the codes, add the descriptions, and then send the letter back up the path to all concerned parties, so that they know what they’re doing.
How much time did that just add to the time it takes to identify, find, copy and send off those records to the RAC? Providers are already under the gun to get the records back to the RAC, and this makes the process all that much more difficult. And needlessly!
A New Way to See the New Issues
For our own internal use, eduTrax developed it’s own database of the new issues, and we are pleased to now make that database available to providers, for their use.
The RAC News Issues Page provides direct links to the four RAC websites. You need not register or login to see these links. Simply go HERE, and choose one of the RAC links.
The RAC New Issues Menu requires you to register, which is free and takes only a minute to do. (You will have to confirm your email address, as a security measure.) Once you login to the site, select the RAC New Issues Page, and a new menu will appear on your left. (preview here)
eduTrax® RAC New Issues Alert Services
This new service now gives you the following choices:
- See New Issues by each RAC — but in a list that is sortable and searchable,
- See New Issues by State — click your state, get a list of the issues approved for that state.
We keep the database updated daily. Currently, we are changing the Issue Title, in our database, so that it is more friendly. For example, we put the MS-DRG number at the front of the title. This makes it easier to search and sort.
To search for an MS-DRG, simply enter the number alone in the Title Search field, then hit Go.
To sort any list by title, simply click on “Issue Title” at the top of the list.
Go HERE to see some instructions on using the sort and search filters.
Soon, we will announce an eMail Alert Service — you get an email from us whenever a RAC posts or changes an issue, and the email will include what got added and/or changed. That way, you stay alerted, and you don’t have to figure out what changed — we do it for you!
More Coming Soon…
So, we recommend you go look at the lists yourself. And watch for the announcement about our new Alerts services.
Also, our next post will include some analysis of the new issues, and what you need to be looking for.
recovery audit contractor
The RAC contracted for the southern and southeastern states, Connolly Healthcare, continues to post new automated issues concerning dose-versus-units-billed, further proving that injections and infusions is a major target for RAC review, and a continuing concern for provider reimbursement, especially for physicians and outpatient settings.
Coding Injections and Infusions — reviews the recent changes to injections and infusions codes and offers guidance on correct capture of these services. (3 minute preview)
In the continuing posting of issues, the RAC contracted for the upper midwestern states, CGI Federal, has now joined Connolly Healthcare in its posting of an issue that can possibly recoup all Medicare Part A charges for an inpatient claim, and still not even touch the dreaded issue of Medical Necessity.
