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Proposed RAC Topics

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Issue Name Review Type Claim Type Region and State Date Posted
4A136-Hospital Services after Date of Death Automated Inpatient Hospital, Outpatient Hospital RAC 1-4
All A/B MACs
11/06/2018
2A158-Cryosurgery of the Prostate Medical Necessity Complex Outpatient Hospital, Ambulatory Surgical Center, Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A150-Evaluation and Management (E&M) Same Day as Admission to a Nursing Facility Automated Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A155-PET Scans Paid without Tracer Codes for IDTF (Independent Diagnostic Testing Facility) Automated Independent Diagnostic Testing Facility RAC 1-4
All A/B MACs
12/4/2018
2A161-Complex Medical Necessity Vertebroplasty and Kyphoplasty (Vetebral Augmentation) Complex Outpatient Hospital, Ambulatory Surgical Ceter, Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
0A174-Complex Chest X-Ray Complex Outpatient Hospital JE, JF 12/4/2018
0A179-IV Hydration Administration Complex Outpatient Hospital JE 12/4/2018
5A149-Pneumatic Compression Device Complex DME by Supplier, DME by Provider RAC 5
DME (A,B,C,D)
12/4/2018
2A159-Cardiac Rehabilitation Complex Outpatient Hospital JM 12/4/2018
2A094-Hyperbaric Oxygen Therapy (HBOT) for Diabetic Wounds Complex Outpatient Hospital RAC 1-4
All States
12/4/2018
4A157-SNF-Consolidated Billing for Therapies Automated Physician/Non-Physician Practitioner, Physical Therapist, Occupational Therapist, Speech Language Pathologist RAC 1-4
All States
12/4/2018
2A147-Medical Necessity Panniculectomy Complex Outpatient Hospital, Ambulatory Surgical Center, Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A139-Initial Observation Services Billed for Subsequent Observation Days Automated Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A140-Inpatient Evaluation and Management (E&M) Visits Billed with no Inpatient Facility Admission Automated Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
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