RAC-Withdrawn Reviews, Explained

James Carroll, for HealthLeaders Media , December 3, 2010

Although this issue is trending up as of late, it's something that's been around for a while, according to a compliance officer at a Georgia hospital in Region C (Connolly).

"Out of 187 records requested, we've had six statuses changed to 'claims closed – not eligible for review,' but these came in the early stages of RACs, and we haven't had any over the past few months."

The burning question for these hospitals and any facility that has experienced similar circumstances is "Why are the RACs doing this?" There may in fact be a number of perfectly logical reasons for RACs to rescind requests, says Keisha Patterson, RAC coordinator at Saint Joseph's Hospital of Atlanta.

  • Untimely review. "If we did not review a request within 60 days of receipt and notify the provider, [the request] would have to be rescinded. We rescinded hundreds of reviews for this reason," she says.
  • Wrong provider type requested. This happened during the demonstration as well as during the current permanent project, according to Patterson. RACs would request records from critical access hospitals when they are not paid via the same reimbursement methodology as OPPS acute care hospitals. "In my experience, they were inadvertently selected by the RACs as they failed to exclude their provider type for some audits."
  • Faulty audit concept. "The erroneous selection of claims due to a faulty audit concept or inaccurate data analysis is also something I've witnessed," she says. "For example, one RAC may have incorrectly selected claims for an audit concept that is approved, but was written incorrectly in their query."
  • Requesting above published limits. During the demonstration, if a RAC requested more than 200 records per 45 days they would have to rescind any requests over that 200 mark, and this would occur due to a number of technical glitches at times, according to Patterson.

Patterson is in a position to know. She worked at a RAC for three years during the demonstration period.

James Carroll is associate editor for the HCPro Revenue Cycle Institute.




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