RACmonitor was founded in 2008 to provide news and information for healthcare providers on the emergence of the government’s Recovery Audit Contractor (RAC) program. From a Centers for Medicare & Medicaid Services (CMS) demonstration in that year, and continuing to the national rollout in 2010 (coincidentally, the year of Monitor Mondays’ national debut), we have been reporting on activities not only of the RACs, but also the Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs), and the Quality Improvement Organizations (QIOs).
But why, after nearly 10 years, do these auditors still tend to get auditing wrong? Providing insight into this issue during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group.
The episode rundown also includes:
- Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.
- Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, returns and reports on all the latest hot topics and the Monitor Mondays Listener Survey.
- News Update: RACmonitor national correspondent Timothy Powell reports on the move by UnitedHealthCare to adjust or deny emergency department (ED) claims submitted with levels four and five evaluation and management (E&M) codes. RACmonitor broke that story with Dr. Hirsch in December of last year.
- Auditing Report: Kristi Pollard, senior coding consultant at Haugen Consulting Group, reports on a top audit finding uncovered by her firm: discrepancies in secondary diagnosis assignment on outpatient claims.
- Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron shares another example of a potentially troublesome issue that could pose a risk to your facility.
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