ting billed. Medical documentation for patients undergoing cardiovascular pro- cedures needs to be complete and sup- port all services provided in the setting billed.” Read the report online at http://
go.cms.gov/12KEgdb. RAC auditor Connolly, Inc., audits claims for a long list of CMS-approved issues,
www.connolly.com/healthcare /pages/
ApprovedIssues.aspx. The au- dit issues applicable to Texas are in the States column of the list with nota- tions of “Novitas Region C,” “Region C,”
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“Texas,” and “TrailBlazer Region C.” For the quarter referenced above, Connolly collected $244 million in overpayments from Region C. CMS released a four-page brochure available online,
http://go.cms.gov /XCvbBg, that summarizes the recov- ery audit process, with a flow chart and links for more information. If you receive an overpayment deter- mination letter from Connolly, review your options,
www.texmed.org/Tem plate.aspx?id=16371. If you decide to appeal, go to Novitas’ online Appeals Center,
www.novitas-solutions.com/ap ppeals/
index.html, to find the forms, process, time frames, and requirements. Your best lines of defense against a
RAC audit are knowledge of coverage policies and regular self-audits. Be sure to follow Medicare guidelines, national coverage determinations, and Novitas JH local coverage determinations when you bill for services. You can learn how to conduct a self- audit, what to do with your findings, and how to obtain buy-in for corrective actions in TMA’s on-demand webinar, Avoiding RAC Audits, accessible online at
http://bit.ly/YKGWaC. Or contact TMA Practice Consulting at (800) 523- 8776 to schedule a coding and documen- tation review. n
Crystal Zuzek is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at
crystal.zuzek@texmed.org.
36 TEXAS MEDICINE June 2013
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