Regular readers know by now that RACGuru.com is a physician oriented website. Hospitals already have plenty of help to address RAC issues – we focus on doctors. So if you’re a physician, here is something you may find interesting.
On April 16th, Connolly Healthcare (Region C) posted 20 new DRGs to their CMS approved list. Nothing new here – RACs are posting new issues all the time – right? Well, yes and no – it’s the kinds of issues here that’s important.
The various DRGs can be classified according to Relative Weight, a number assigned to each procedure which indicates its relative monetary value. Without getting technical, a low number means lower value. Many procedures are ones, twos or threes. A high Relative Weight carries a high dollar value, and if you’re being paid on commission (the more politically correct term would be “contingency fee”) as the RACs are, high Relative Weights mean bigger paychecks!
So What’s Connolly Up To?
Who knows? They’re not saying, but maybe we can learn something about the enemy’s tactics by reading their mail.
Eight out of Connolly’s 20 new issues carry very high Relative Weights. Some carry extremely high Relative Weights – at or over 10.0 – such as heart transplants (24.85), Liver or Intestinal Transplants (10.4), Extensive Burns or Full Thickness Burns with Mechanical Ventilation 96+ Hours with Skin Graft (13.74), Lung Transplants (9.45), ECMO or Tracheotomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. (18.27).
Six of the new postings are in the top 25% discharge rates, meaning that Connolly is not only going after high dollar items – they’re also stepping up the volume.
So . . . . How Does This Affect Me?
As we have said before, it’s only a matter of time before the RACs hit physicians. Bottom line – if they’re hammering the hospitals (and they are) and already have the medical records in their possession (and they do), is it reasonable to think they won’t be coming after the surgeons who did the operations and the physicians who admitted the patients?
We can’t emphasize too strongly – the smart thing to do is get compliant now! If you haven’t arranged to get an outside audit (the first step) you need to. Once the bleeding starts, you will need help and we will be here for you – but you’ll wish then that you had done something now.
Winston Creath is an independent healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics. He serves as President of National Business Solutions of GA, LLC. He can be reached at firstname.lastname@example.org for questions or comments.