Recent postings of approved review issues by Connolly Healthcare, the recovery audit contractor for Medicare Region C, are part of a "continuing a pattern of confusing and incomplete information," according to a report by HIM on Call.
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
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