Pediatric Coding Alert
Medicaid Will Implement RAC Audits Jan. 1, CMS Says
Recent delays have given you more time to prepare. You've benefited from several delays in Medicaid RAC audits, but as of Jan. 1, 2012, the time will finally come when those audits will kick in. As we reported in Vol. 14, No. 4 of Pediatric Coding Alert, "recovery audit contractors" (RACs), which the federal government has hired to audit physician claims, will be reviewing Medicaid claims soon thanks to last year's Patient Protection and Affordable Care Act. Although RAC audits were originally slated to impact Medicaid claims on April 1, 2011, CMS delayed that date, and did not make a subsequent announcement until Sept. 14, at which point the Federal Register posted a final rule indicating the audits will begin on Jan. 1, 2012. In place for Medicare contractors since 2005, RACs are often referred to as medical "bounty hunters" because they only make money if they collect overpayments from you. Their income is specifically tied to the amount they recover, and is based on a percentage of the overpayments they identify. To review the Federal Register article, visit www.ofr.gov/OFRUpload/OFRData/2011-23695_PI.pdf.
Pediatric Coding Alert
- Vaccine Products:
Fighting Denials for Male HPV Vaccines? Try These Strategies
Let staff know about carrier challenges, and prepare a waiver when necessary. Nearly two years [...] - Icd-9 Coding Quiz:
How Well Do You Know the New ICD-9 Codes?
New codes take effect on Oct. 1--Find out if you're ready.October 1 is just around [...] - Clip and Save:
Tackle HPV Vaccine Payment Woes With A Solid Financial Responsibility Form
The more specific your form is, the better your payment odds.If you aren't having your [...] - You Be the Coder:
Nail Down Pilonidal Cyst Details
Question: Can you help me with CPT® code assignment for this procedure? The chart note reads: [...] - News You Can Use:
Medicaid Will Implement RAC Audits Jan. 1, CMS Says
Recent delays have given you more time to prepare. You've benefited from several delays in [...] - Reader Question:
New Problems May Not Mean New Patient Visit Codes
Question: Our office saw a patient six months ago for a certain condition, and sent [...] - Reader Question:
Don't Let Wheezing Dx Trip You Up
Question: Sometimes our physician suggests diagnosis 519.11 for wheezing, but sometimes he suggests 786.07. How [...] - Reader Question:
Modifier 55 Won't Apply to Suture Removal
Question: An 11-year-old established patient went to the emergency room in another state over the [...] - Compliance:
Make Sure Your Billing Service Isn't Putting You at A Compliance Risk
This billing service overcharged Medicaid by millions for physicians' charges.If your pediatric practice has hired [...]
