Lucien Newman III, MD, the founder of ComplyMD, a documentation and coding software solution, listed nine common targets for recovery audit contractors involving surgeons in 2010 in a report in General Surgery News.
Here are nine common RAC targets involving surgeons:
1. Colon procedures unrelated to the primary diagnosis
2. IV hydration requirement issues
3. Blood transfusions
4. Bronchoscopy
5. One-day stays for chest and abdominal pain
6. Inpatient rehabilitation admissions
7. Debridement
8. Evaluation and management visits
9. Outpatient physical therapy
"In many of the cases above, the error is obvious, but poorly documented in the record," Dr. Newman stated. For example, "anemia without specificity" may not justify a transfusion, which then creates a documentation error. An error can also be created when a patient is admitted with chest pain and during the stay requires debridement of an ulcer that wasn't previously documented.
Poor coding and documentation harms hospitals
Only 2 percent of audit dollars are extracted from physician providers, compared with 85 percent for hospitals. While practices may be in less danger, "a provider's poor habits can cause his or her hospital to lose large sums of reimbursement," he warned. Also, because inpatient hospital bills tend to be higher, "failure to document changes that occur acutely on inpatients tends to be costly," he wrote.
Dr. Newman said surgeons can become involved in RAC audits due to the following four kinds of mistakes:
1. Providing services that are not covered
2. Performing medically unnecessary services
3. Incorrectly coding services
3. Duplicating services
Few physicians get any training and experience with coding and documentation, but the arrival of electronic health records and other solutions at hospitals should make the process easier, Dr. Newman wrote.
Read the General Surgery News report on RACs.
Learn more about ComplyMD.
Read more about RACs and physicians:
- CMS Will Encourage RACs to Extrapolate Overpayments
- Physicians Doing Work of RACs, Study Seems to Indicate
- Payor Denials Overturned in 39-59% of Appeals, GAO Finds
Here are nine common RAC targets involving surgeons:
1. Colon procedures unrelated to the primary diagnosis
2. IV hydration requirement issues
3. Blood transfusions
4. Bronchoscopy
5. One-day stays for chest and abdominal pain
6. Inpatient rehabilitation admissions
7. Debridement
8. Evaluation and management visits
9. Outpatient physical therapy
"In many of the cases above, the error is obvious, but poorly documented in the record," Dr. Newman stated. For example, "anemia without specificity" may not justify a transfusion, which then creates a documentation error. An error can also be created when a patient is admitted with chest pain and during the stay requires debridement of an ulcer that wasn't previously documented.
Poor coding and documentation harms hospitals
Only 2 percent of audit dollars are extracted from physician providers, compared with 85 percent for hospitals. While practices may be in less danger, "a provider's poor habits can cause his or her hospital to lose large sums of reimbursement," he warned. Also, because inpatient hospital bills tend to be higher, "failure to document changes that occur acutely on inpatients tends to be costly," he wrote.
Dr. Newman said surgeons can become involved in RAC audits due to the following four kinds of mistakes:
1. Providing services that are not covered
2. Performing medically unnecessary services
3. Incorrectly coding services
3. Duplicating services
Few physicians get any training and experience with coding and documentation, but the arrival of electronic health records and other solutions at hospitals should make the process easier, Dr. Newman wrote.
Read the General Surgery News report on RACs.
Learn more about ComplyMD.
Read more about RACs and physicians:
- CMS Will Encourage RACs to Extrapolate Overpayments
- Physicians Doing Work of RACs, Study Seems to Indicate
- Payor Denials Overturned in 39-59% of Appeals, GAO Finds