|RAC To Target High-Level E/Ms|
RAC To Target High-Level E/Ms
According to the Medical Group Management Association (MGMA), the Centers for Medicare & Medicaid Services (CMS) has authorized the Region C RAC (Recovery Audit Contractor) to undertake the targeted review of level-5 evaluation and management (E/M) services. The states falling under the aegis of this regional RAC are: Ala., Ark., Colo., Fla., Ga., La., Miss., N.M., N.C., Okla., S.C., Tenn., Tex., Va., and W.Va.
The reason I bring this issue to your attention is because I have spoken with so many pain physicians throughout the country who revealed that they routinely or even exclusively submit high-level E/M claims. Their rationale is that a preponderance of their patients are older with a whole panoply of problems, disorders and syndromes. This may be, but this does not remove the target that is now squarely on your back. Therefore, proceed with greater caution; be even more judicious when selecting the appropriate code for the service performed; and make sure you are familiar with the 1997 Guidelines, as referenced above. (A copy can be obtained from this CMS website.) In addition, you should seek to distill these documentation requirements down to a bulleted template format for ease of use.)
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