Audits:
RAC Posts Painful HHA Audit Topic
Published on Wed Aug 08, 2012
Brace for complex medical review based on medical necessity and eligibility.Get ready to feel the RAC pain other pro-viders have become accustomed to.Region C Recovery Audit Contractor Con-nolly Inc. has posted this HHA issue: "Medical Necessity and Conditions to Qualify for Services." According to the RAC for 15 states and two U.S. territories, the "medical record will be reviewed to validate that the Home Health Services provided were both reasonable and medically necessary, and that the patient met the conditions to qualify for Home Health Services." The review will cover claims back to October 2007, Connolly says."This is definitely not good news," warns consultant Pam Warmack with Clinic Connec-tions in Ruston, La. "In my dealings with providers I find that documentation to support medical necessity is often lacking."The problem: "Medical necessity is one of the top two reasons for denials from most of the MACs," Warmack laments. "Medical necessity can [...]
