Connolly, the RAC for 17 states, from Colorado to Virginia, recently posted 35 new issues on its website, apparently involving around 100 DRGs. But RACs don’t have to use a specific format for postings, wrote RAC consultant Ernie De Los Santos. In fact, Connolly’s posting identifies “no MS-DRGs whatsoever, only citing disorders, conditions or procedures in rather generalized terms,” Mr. De Los Santos wrote. It appears that “Connolly intends to include broad ranges of MS-DRGs under those issues,” he added.
Connolly has recently posted issues when medical necessity was approved, then replaced the posting with an edited version as if it were a new issue, removing the phrase, “at this time, medical necessity excluded from review.”
Mr. De Los Santos specified 30 new postings involving a combined total of 94 DRGs approved for DRG validation review.
Read the HIM on Call report on RACs.
Read Connolly’s approved issues.
Read more coverage of RACs:
–4 Ways Medicaid RACs Could Differ From Medicare RACs
–RACs Plan to Target Physicians’ Charges
-7 Concerns About the Upcoming Implementation of Medicaid RACs
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
