New RAC Audits Posted

New RAC Audits Posted

Region A

Performant Recovery, the recovery audit contractor (RAC), posted a complex review for automatic external defibrillators on December 26 that will specifically look at claims billed without an indication supporting medical necessity as described in the NHIC Local Coverage Determination (LCD) L13613 and related article (A23905). This Audit impacts providers in CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI and VT, and will apply to claims paid over the past three years.

More details can be found at https://www.dcsrac.com/IssuesUnderReview.aspx.

Region B

CGI Federal, the RAC for Region B, posted an automatic review for CPAP without OSA diagnosis on December 18. Claims with dates of service from August 1, 2010, forward will be subject to automatic review and recoupment, and impacts providers in MN, WI, MI, IL, IN, OH and KY.

More details can be found at https://racb.cgi.com/Issues.aspx.

Region C

Connolly, the Region C RAC, posted a prepayment review of pressure reducing support services on December 3. The review will look specifically at claims pre-pay that do not meet the indications of coverage and/or medical necessity related to local coverage determinations. The review covers claims within three years of the determination date and impacts providers in FL, TX, LA and NC.

Please be aware of which region your business operates in and be prepared for these audits.

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