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Will the RACs audit E/M services?

April 14th, 2009 - Codapedia Editor
Categories:   Audits/Auditing   Compliance  
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This is the $10,000 question: will the RAC auditors, now in place throughout the country, look at E/M services?

Here is what CMS says in its FAQ on the topic:

From their website: 
Will the Recovery Audit Contractors (RAC) review evaluation and management (E&M) services on physician claims under Part B?

Yes, the review of all evaluation and management (E & M) services will be allowed under the RAC program. The review of duplicate claims or E & M services that should be included in a global surgery were available for review during the RAC demonstration and will continue to be available for review. The review of the level of the visit of some E & M services was not included in the RAC demonstration. CMS will work closely with the American Medical Association and the physician community prior to any reviews being completed regarding the level of the visit and will provide notice to the physician community before the RACs are allowed to begin reviews of evaluation and management (E & M) services and the level of the visit.

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