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BLOG: Region C RAC auditor to review E/M services in physician offices

The Centers for Medicare and Medicaid Services has approved the Region C Recovery Audit Contractor (RAC) Connolly, Inc. to review incorrect billing for evaluation and management services in physician offices (specifically including CPT code 99215).  According to the group's website, auditing began on Sept. 12 and can include claims reaching back to October 2007.

The American Medical Association and other professional societies have come out strongly in opposition to RAC audits of E/M services.  In a letter posted on September 11, the AMA urged CMS to rescind its decision due to the fact that E/M services are too complex to be assessed through a standard medical necessity review.  A copy of the AMA’s letter can be accessed through the group’s website.

Ted Lotchin, JD, MPH, can be reached at Arnold & Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-5250; email: Ted.Lotchin@aporter.com