CMS Initiating RAC Audits of E&M Services; Unknown if North Carolina is Included

The Centers for Medicare & Medicaid Services (CMS) recently approved Connolly, the Medicare Region C Recovery Auditor (RAC), to begin conducting audits of Evaluation & Management (E&M) service coding in physician offices. Specifically, they will be auditing use of Current Procedural Terminology (CPT®) code 99215.

Pressure has been mounting on CMS to review physician coding of E&M services, as evidenced by a Health and Human Services Office of Inspector General (OIG) report on this topic issued last May. In the next several weeks, Connolly will begin complex medical review of CPT code 99215, and will be permitted to extrapolate their findings based on a statistical sample of claims. Connolly is the Medicare FFS RAC contractor who conducts RAC audits in North Carolina. It has not yet been announced if North Carolina will be under review. Nonetheless, these reviews are expected to begin soon.  

The AMA sent a letter to Acting Administrator Marilyn Tavenner strongly objecting to these audits and urging CMS to rescind its approval of the RAC’s E&M coding review. The letter also requested that the agency provide briefings for state medical societies and specialty societies to hear their concerns.

Watch the NCMS Bulletin for updates on this issue.


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1 Comment

  • So the War on Doctors has begun.. Maybe rather than a strongly worded letter we should have the AMA call a press conference and denounce the declaration of war on primary care Doctors. As if we didn’t have enough challenges staying in practice, CMS declares war on primary care Doctors. I have but one question. Where’s the outrage from the professional organizations?????