Two recovery audit contractors recently posted issues on their sites. But, like many RAC postings in the past, they present "confusing, incomplete and oftentimes contradictory information," wrote Ernie de los Santos, CIO for eduTrax, on the RAC Monitor website.
Connolly Healthcare, the RAC for Region C recently posted 77 new issues, and DCS, the RAC for Region A, posted seven new issues. While RACs are required to post their approved issues, they do not follow any format.
Connolly's new postings, at 17,000 words, contain the largest amount of changes made on any of the four RAC websites. But of Connolly's 70 MSDRGs approved for Medical Necessity Review, only 46 are identified separately and the rest are buried inside lists of MS-DRGs also approved for DRG validation.
"This method of listing the MSDRGs requires the reader to compare the two long lists of MSDRGs in the posting in order to determine which MSDRGs are approved for Medical Necessity Review," Mr. de los Santos wrote.
DCS' postings are also confusing. Only three of the seven list the MSDRGs in the title field and the title of one issue suggests it covers MDC 18, but it actually includes 16 of the 17 MSDRGs in that MDC. And another issue title suggests it covers MDC 1, but only lists five of the 75 MSDRGs in that MDC.
Supposedly, RACs are required to post new issues in the same exact language that was used submitting their proposed changes to CMS, but this is apparently not happening, Mr. de los Santos wrote.
Read Ernie de los Santos report on the RAC Monitor website.
Read Connolly's approved audit issues.
Read DCS' issues under review.
Read more coverage on RACs:
- RACs Can Request Claims Not on Approved List
- RACs Starting to Audit Physicians' E/M Codes
- 10 Tips on Improving RAC Readiness From Kaiser's RAC Expert
Connolly Healthcare, the RAC for Region C recently posted 77 new issues, and DCS, the RAC for Region A, posted seven new issues. While RACs are required to post their approved issues, they do not follow any format.
Connolly's new postings, at 17,000 words, contain the largest amount of changes made on any of the four RAC websites. But of Connolly's 70 MSDRGs approved for Medical Necessity Review, only 46 are identified separately and the rest are buried inside lists of MS-DRGs also approved for DRG validation.
"This method of listing the MSDRGs requires the reader to compare the two long lists of MSDRGs in the posting in order to determine which MSDRGs are approved for Medical Necessity Review," Mr. de los Santos wrote.
DCS' postings are also confusing. Only three of the seven list the MSDRGs in the title field and the title of one issue suggests it covers MDC 18, but it actually includes 16 of the 17 MSDRGs in that MDC. And another issue title suggests it covers MDC 1, but only lists five of the 75 MSDRGs in that MDC.
Supposedly, RACs are required to post new issues in the same exact language that was used submitting their proposed changes to CMS, but this is apparently not happening, Mr. de los Santos wrote.
Read Ernie de los Santos report on the RAC Monitor website.
Read Connolly's approved audit issues.
Read DCS' issues under review.
Read more coverage on RACs:
- RACs Can Request Claims Not on Approved List
- RACs Starting to Audit Physicians' E/M Codes
- 10 Tips on Improving RAC Readiness From Kaiser's RAC Expert