Third RAC Region Begins Medical Necessity Reviews

Written by Leigh Page | August 31, 2010

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Following authorization from CMS on Aug. 6 to begin medical necessity reviews of 18 types of medical conditions, three Medicare recovery audit contractors have announced the start of such review, according to AHA News Now.

Connolly Consulting, the RAC for Region C, covering the South plus New Mexico, recently announced starting the reviews. Only Diversified Collection Service, the RAC for Region A, covering New York and New England, has not made an announcement yet.

Once RACs have announced the reviews on their websites, they can begin requesting medical charts for medical necessity review audits. These audits are the first to examine medical necessity. Medical necessity audits were an area of contention during the RAC demonstration project due to concerns about a lack adequate clinical and Medicare knowledge by RAC auditors.

Read the AHA News Now report on recovery audit contractors.

Read more on recovery audit contractors.

- RACs to Begin Medical Necessity Review Audits

- Hospitals Report Details of RAC Activities in First Quarter of 2010

- CMS Announces New Limits on RAC Requests for Medical Records

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