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Monday, September 24, 2012

AMA TO CMS: STOP RAC AUDITS OF MEDICARE E&M CODES

The American Medical Association has come out swinging against the federal government’s announcement that Recovery Auditor Contractor (RAC) Connolly, Inc. may begin auditing Medicare coding for CPT 99215 (evaluation and management [E&M] of an established patient) in physician offices in Texas and several other states. “Physicians who provide E&M care apply complex decisionmaking based on myriad clinical approaches, including research and review of patient medical history, analyses regarding appropriate medication, discussion of home situation and prescription distribution plan, preventive care planning, and many other variables,” AMA Executive Vice President James Madera, MD, wrote in a letter asking the Centers for Medicare & Medicaid Services to stop the audits before they begin. “In particular, based on our historical experience with the RACs, and in light of the fact that the RACs are not required to have same-specialty physicians review RAC determinations, we have no confidence that the RACs will be up to the task of understanding these variables or their clinical relevance.”

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