Harmony Healthcare Blog

Medicare ADR's and RAC Audits

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jun 02, 2010

Additional Development Requests
When a Medicare contractor (MAC) cannot make a coverage or coding determination from the information that has been provided on a claim and its attachments, then the facility may be asked  for additional documentation and receive an Additional Development Request (ADR). The MAC  requests records related to the claim(s) being reviewed, and may collect documentation related to the patient's condition before and after a service in order to get a more complete picture of the patient's clinical condition.

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Topics: ADR, Compliance, RAC Audit

RAC Audits

Posted by The Harmony Team on Wed, May 26, 2010

RAC Issues Under Review
Harmony has been asked how facilities will know what RAC Audit issues have been identified and are currently under Medical Review.  Once CMS approves an issue for review, the RAC will place the issue on their Web site. Providers should check the RAC website regularly to see all issues that have been approved by CMS and are being audited by the RAC.  Each Recovery Audit contractor is required to post the current issues under Medical Review for their region.  You can find this page on the website for the RAC covering each of the four regions.  
DCS who is the chosen RAC for Region A is addressing the following issues: https://www.dcsrac.com/issues.html
Region B issues:  https://racb.cgi.com/Issues.aspx
Region C issues: https://www.connollyhealthcare.com/RAC/pages/approved_issues.aspx
Region D approved issues: https://racinfo.healthdatainsights.com/Public/NewIssues.aspx
Harmony conducts Pre-RAC Medical Reviews to assist facilities in composing documentation and maintaining supportive medical records which represent all services provided.  Harmony educates on how to handle Help Letters and denied claims.

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Topics: CMS, RAC Audit

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