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Healthcare News: Special MLN Matters highlights physician RAC vulnerabilities

December 14, 2010

CMS identified two high-risk vulnerabilities for physician claims under the Recovery Audit Contractor (RAC) program, according to special MLN Matters® article SE1036.

CMS cited two claims of more than $1 million that RACs denied. On one claim for more than $6 million, the units billed exceeded the number of units per day based on the CPT® code descriptor, reporting instructions in the CPT Manual, and/or other CMS local or national policy. In the second instance, the physician billed and was paid for two claims for the same beneficiary, for the same date of service, and same CPT code. 

CMS noted that the two findings cited in the MLN Matters article involved multiple CPT codes. CMS published the findings to educate physicians so they can avoid similar problems in the future.