While waiting for the Centers for Medicare & Medicaid (CMS) Services to begin the recovery audit contractor (RAC) prepayment review demonstration originally slated to begin in January, the Journal of the American Health Information Management Association published a guide to prepare for the audits and encouraged healthcare organizations to be proactive.
The CMS’ RAC prepayment review demonstration is intended to determine whether conducting audits prior to making Medicare payments can positively impact the amount of improper payments.
The demonstration program is being launched in 11 states and will target diagnosis-related groups (DRG) disproportionately associated with improper payments, including:
- MS-DRG 312, syncope and collapse;
- MS-DRG 069, transient ischemia (TIA);
- MS-DRG 377, gastrointestinal (GI) hemorrhage with most common cause (MCC);
- MS-DRG 378, gastrointestinal (GI) hemorrhage with CC;
- MS-DRG 379, gastrointestinal (GI) hemorrhage without a CC or MCC;
- MS-DRG 637, diabetes with MCC;
- MS-DRG 638, diabetes with CC; and
- MS-DRG 639, diabetes without a CC or MCC.
“Inpatient coders should be cognizant of the RAC prepayment MS-DRGs, and ensure that the correct code and corresponding MS-DRG are assigned,” Chris Dimick wrote in the Aug. 1 article. “Coders and coding managers may want to consider a second-level review of these cases to verify the code assignments and sequencing. Oftentimes, these short-stay admissions can be a coding challenge, given the limited documentation in the medical record.”
The complete guide can be read here.