Tag Archives: RAC

CMS has heard them too!  So many myths in fact that they just published a document on December 18 called, “RAC Program Myths.“ It was put together in a very familiar question and answer type format. I’ve heard a few of these myths and have blogged on several of these topics; perhaps you want the real answer.  I encourage you to…
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If you need to educate staff about the importance of documentation and protecting hard earned revenue, you need to look no farther than an excellent resource provided by the Medicare Learning Network  entitled ‘Contractor Entities At a Glance,’ this comprehensive chart provides entity name, definitions and responsibilities along with the reasons those particular agencies may contact you.  In a few short…
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In the post-acute care venue, there is much debate on exactly what is the correct level of care required to get the patient back to their home setting. “Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidenced-based clinical standards of care,” per Wikipedia definition. Medicare’s definition is the same;…
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There is much work that goes into the pre-admission screen and the specificity required to make a solid decision for appropriateness to admit. And yet with so much information, what are the other important elements to defend a solid case of medically necessary care at an IRF? Two things that come to my mind are the time required to fulfill…
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If you feel you still have to convince MACs and RACs, we know exactly what documentation is required to defend medically necessary care at the IRF rehabilitation level, listen up; the documentation stated in the pre-admission screen should without a doubt hold that defense. Here is how I see it. In April, I blogged about the listed criteria stated within…
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On February 24, 2011, the Office of Inspector General (OIG) posted a final report, A-01-10-00518, stating that, “IRFs incorrectly coded 24 of the 53 claims reviewed with patient status code 05.” In PAI language, this translates to a “skilled nursing facility.” Unfortunately, the uniform bill is not encoded the same. This resulted in a $245,090 overpayment. An error rate of…
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