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
