RAC Update from the American Hospital Association

The American Hospital Association released a helpful Recovery Audit Contractor Program Update dated October 5, 2009. There is a password required.

The report is also available on the Ohio Hospital Asssociation website as well.

A few highlights:

  • To date, CMS has approved only automated audits, which rely on software analysis to find technical errors such as coding errors.
  • CMS has delayed approval of complex audits, including medical necessity reviews, in order to finalize processes and policies related to requesting and auditing medical records.
  • DRG and coding validations are likely to begin in November 2009 at the earliest, with medical necessity reviews delayed until 2010.AHA has made available to all hospitals a free claim-level Excel tool to assist in tracking RAC audits.

Expect RAC Audits in Ohio Before Year-End

CGI Technologies and Solutions, Inc. is the RAC contractor for Region B, which includes Ohio.  Provider outreach started in September and, according to CGI's website, will be done by the end of September.  CGI is already operational in Indiana, Michigan, and Minnesota, so expect RAC audits to start in Ohio before the end of the year.  CGI's RAC website is located at racb.cgi.com/Default.aspx