An article in the August issue of the Journal of AHIMA walks through the Recovery Audit Contractor “Prepayment Reviews” that Medicare soon will start as a demonstration program.

These audits, initially in 11 states, are in addition to the prospective audits of claims already being routinely done. The prepayment audits will cover short hospital stays of two days or less, as well as longer stays, with a group of eight DRGs being subject to review for short stays, according to the AHIMA article.

“Inpatient coders should be cognizant of the RAC pre-payment MS-DRGs, and ensure that the correct code and corresponding MS-DRG are assigned,” the article advises. “Coders and coding managers may want to consider a second level review of these cases to verify the code assignments and sequencing.”

The AHIMA article, “Preparing for RAC Prepayment Reviews,” is available here.

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