After hearing RACs were requesting claims not on the approved list, Mr. Spencer says he asked a CMS official and confirmed that a provider is obligated to fulfill any request that a RAC makes, even if it is not on the list.
Mr. Spencer says in these cases, the RAC may be conducting a probe to determine whether a particular type of claim should be put on the approved list.
Citing an example of a RAC making such request, he says the Region D RAC made additional documentation requests for 120 claims for E/M services submitted by a practice in Nevada. Parenthetically, it was the first time Mr. Spencer heard of a practice undergoing a complex review.
Find out more about Fi-Med Management.
Read more coverage of RACs:
– RACs Starting to Audit Physicians’ E/M Codes
– 10 Tips on Improving RAC Readiness From Kaiser’s RAC Expert
– 6 RAC Issues For Hospitals in 2011
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