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Proposed RAC Topics

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Issue Name Review Type Claim Type Region and State Date Posted
Lab Services Rendered During an Inpatient Stay Automated Lab RAC 1-4
All States
02/14/2018
Cataract Removal – Excessive Units by Physician (Partial Denial) Automated Physician/Non-Physician Practitioner RAC 1-4
All States
02/14/2018
Cataract Removal – Excessive Units by Physician (Full Denial) Automated Physician/Non-Physician Practitioner RAC 1-4
All States
02/14/2018
Ancillary Services Billed without an Approved Surgical Procedure Automated Ambulatory Surgery Center RAC 1-4
All States
02/14/2018
CSW (Clinical Social Workers) during Inpatient Stay Automated Clinical Social Workers CMS 1-4
All States
02/14/2018
Technical Component of Lab/Pathology for Outpatient Hospitals Automated Physician/ Non-Physician Practitioner RAC 1-4
All States
02/14/2018
Labs Subject to Part B Consolidated Billing by Clinical Lab – End Stage Renal Disease (ESRD) Automated Professional Services (Physician/Non-Physician Practitioner) RAC 1-4
All States
02/14/2018
Observation Evaluation & Management (E&M) Services Billed Same Day as Inpatient Admission Automated Professional Services (Physician/Non-Physician Practitioner) RAC 1-4
All States
02/14/2018
Ventilators Subject to ACA Requirements Prior to January 1, 2016 Complex DME Supplier, DME by Physician RAC 1-4
All States
02/14/2018
Exact Duplicate Claims Automated Physician/ Non-Physician Practitioner RAC 1-4
All States
2018-04-01
Implantable Automatic Defibrillators Complex Outpatient Hospital, ASC, Physician/Non-Physician Practitioner RAC 1-4
All States
2018-04-01
Group 3 Support Surfaces Complex DME Supplier, DME by Physician RAC 1-4
All States
2018-04-01
Percutaneous Implantation of Neurostimulator Electrode Array Complex Physician/Non-Physician Practitioner, Outpatient Hospital, Ambulatory Surgical Center RAC 1-4
All States
2018-04-01
4A084-MSU Overpayments Automated Professional Services (Physician/Non-Physician Practitioner) RAC 1-4
All States
2018-05-01
4A089-Unbundling of Critical Care Automated Professional Services (Physician/Non-Physician Practitioner) RAC 1-4
All States
2018-05-01
4A080-MSU Underpayments Automated Professional Services (Physician/Non-Physician Practitioner) who perform surgical procedures RAC 1-4
All States
2018-05-01
4A091-Skilled Nursing Facility (SNF) Consolidated Billing Automated Outpatient Facility RAC 1-4
All States
2018-05-01
4A098-Add-on codes paid without Primary Code and/or denied Primary Code – by Clinical Laboratory Automated Laboratory RAC 1-4
All States
2018-05-01
Facet Injections Complex Outpatient Hospital, Ambulatory Surgery Center (ASC) RAC 1-4
All States
2018-05-15
1A076-Outpatient Hospital Comprehensive APC Coding Complex Outpatient Hospital RAC 1-4
2018-06-05
0A078-Home Oxygen Complex DME by Supplier, DME by Physician RAC 5
All States
2018-06-05
0A086-Urological Supplies Complex DME by supplier, DME by physician RAC 5
All States
2018-06-05
2A094-Hyperbaric Oxygen Therapy for Diabetic Wounds Complex Outpatient Hospital RAC 1-4
All States
2018-06-05
4A097-Add Ons paid without a Primary and/or Denied code by ASC Automated Ambulatory Surgery Center RAC 1-4
All States
2018-06-05
1A104- Physician Services during Hospice Period Automated Physician/Non-Physician Practitioner RAC 1-4
All States
2018-06-05
4A061-Facet Injections Complex Outpatient Hospital/Ambulatory Surgery Center RAC 1-4
All States
2018-05-01
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