• Targeted areas will be based on two factors:

• The results of the RAC Demonstration Project
• Comprehensive Error Rate Testing Program (CERT)

• Results from the demonstration project indicate that most of the retrieved revenue came from the inpatient setting (85%). Make sure your physicians are documenting efficiently and signing test orders, drug orders, etc.

• Support the inpatient consults with appropriate documentation:

• Documentation of the request for an opinion from a qualified individual
• Documentation that the referring physician will be collaborating on the case.

• Make sure your physicians are documenting a chief complaint on all subsequent hospital care visits (follow up hospital visit 99231-99233). This is an easy one for RAC’s since many physicians never document a chief complaint in the hospital.

• RAC’s WILL be looking at E&M visits. Make sure that your physicians BONE UP on their documentation techniques and are coding correctly.

• Look at the most recent CERT report: https://www.cms.hhs.gov/apps/er_report/preview_er_report.asp?from=public&which=long&reportID=9&tab=4. Look for the areas that have a high error rate. See if you are efficient in that area. That will likely be where the RAC’s will look.