Revenue Cycle

Providers receive first RAC medical record documentation requests

Recovery Auditor Report, December 24, 2009

Requests for medical records are already arriving in hospital mailboxes following the approval of the first set of issues for complex RAC review earlier this week.
 
Connolly Healthcare was approved to audit a number of DRG validation issues in the following Region C states: Alabama, Colorado, Florida, Georgia, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas.
 
One hospital in southern Alabama has already received a number of documentation requests for various issues. Two of the hospitals in their system received a total of 38 requests before December 11 auditing the following DRGs:
  • MS-DRG 163 (Major chest procedures with MCC)
  • MS-DRG 164 (Major chest procedures with CC)
  • MS-DRG 167 (Other respiratory system OR procedures with CC)
  • MS-DRG 207 (Respiratory system diagnosis with ventilator support 96+ hours)
  • MS-DRG 329 (Major small and large bowel procedures with MCC)
  • MS-DRG 394 (Other digestive system diagnoses with CC)
  • MS-DRG 432 (Cirrhosis and alcoholic hepatitis with MCC)
  • MS-DRG 871 (Septicemia or severe sepsis without MV 96+ hours with MCC)
  • MS-DRG 872 (Septicemia or severe sepsis without MV 96+ hours without MCC)
  • MS-DRG 981 (Extensive OR procedure unrelated to principal diagnosis with MCC)
  • MS-DRG 983 (Extensive OR procedure unrelated to principal diagnosis without CC/MCC)
  • MS-DRG 987 (Non-extensive OR procedure unrelated to principal diagnosis with MCC)
  • MS-DRG 988 (Non-extensive OR procedure unrelated to principal diagnosis with CC)
  • MS-DRG 989 (Non-extensive OR procedure unrelated to principal diagnosis without CC/MCC
Another Alabama hospital reported receiving its first documentation requests December 8. The hospital is in the process of gathering together the requested documentation. In addition, the RAC team, which includes HIM, case management, nursing, compliance, finance and other staff members, plans to meet next week to look at the requested documentation and related process.

Alabama, however, is not the only state with providers reporting RAC documentation request. A six-hospital system in Tennessee received 57 requests as of December 9. The hospital worked diligently prior to the start of the RAC program to prepare, and so far, it has paid off. “Everything is working beautifully,” according to one hospital employee. “So far things have been pretty calm.”

Certainly, now that Connolly Healthcare has been approved to audit for DRG validation, other providers across Region C should begin to see their first documentation requests in the near future, if they haven’t received them already.

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