Posts Tagged: medical coding education

CMS Delays RAC Permanent Program

On November 4, 2008, the RAC Recent Updates page of the CMS website, CMS confirmed any work under the permanent RAC contract awards is on hold pending the outcomes of protests filed with the GAO by two unsuccessful bidders (Viant, Inc. and PRG Schultz, USA, Inc.) for the permanent RAC program.

Evidently, this action requires an automatic stay of work, as required by the Competition and Contracting Act of 1984 (CICA). CMS will now stop work under all 4 of the permanent RAC contract awards until a determination is made by the GAO. Under the CICA, the GAO has 100 days to issue its decision, which means that a decision would be due on the protests in early February 2009.

What does this mean for providers?  VERY LITTLE. All it means is that there will be a DELAY in requests being sent out for medical records and subsequent investigations of them.

This does NOT mean that the program is being stopped or eliminated.

All of your plans for preparing for the RAC program and its audits are still valid and necessary.

All this means is that some contractors are unhappy that they don’t get to collect the commissions for auditing your work.

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Losing FTEs

Because of the recent focus by RACs on one-day stays, we have been doing internal audits recently at several client facilities, concerning those kind of claims.  VERY often, we are finding this kind of error rate:

Greater than 50% errors.

The facilities wind up just writing off those claims. Period.

What does that cost a facility? We were at a facility where their rate was over 60% errors, in a single 60-day period. That added up to over $30,000.

That’s at least equal to one FTE. Lost, due to poor documentation and/or coding.

We’re doing some calculations for a client facility to be able to show to their MDs. Maybe you’d like to know how many FTEs your facility is losing, simply because of a lack of education about optimal documentation & coding practices.

Keep checking back, we’ll share some of the calculations with you.

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