RAC audits begin in South Carolina

CMS announced Tuesday it will begin automatic audits of providers in South Carolina for certain Medicare codes. This is just the beginning of nationwide audits under Medicare’s Recovery Audit Contractor (RAC) program. The audit contractor, Connolly Consulting, will first target physicians and hospitals in South Carolina. For this first round of edits in South Carolina, Connolly Consulting will review blood transfusions, untimed codes, IV hydration therapy, bronchoscopy services, once-in-a-lifetime procedures, pediatric codes exceeding age parameters and injections of pegfilgrastim for 6 mg. Connolly Consulting will issue letters to hospitals and physicians as soon as this month who may have billed Medicare incorrectly for these particular codes. Notified providers will have to prove they billed Medicare correctly or return the reimbursements.