ACC: Complex office visits face scrutiny by Medicare RACs in some states

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 - target, magnifying glass, investigate

The American College of Cardiology (ACC) has announced that Connolly, the Medicare Recovery Auditor Contractor (RAC) for Region C, has received approval to conduct in depth medical review on claims submitted for complex office visits, specifically those billed with CPT code 99215. Affected states include Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico and the U.S. Virgin Islands.

Because of the type of review being conducted, according to the ACC, the RAC will be permitted to extrapolate their findings based on a statistical sample of such claims. The Centers for Medicare & Medicaid Services (CMS) does expect to receive requests from other RACs to review for the same or similar code(s), the college said.

The ACC, along with the physician community, raised concerns three years ago with respect to potential audits of evaluation and management services. The College continues to raise these concerns and will work with the American Medical Association (AMA) and other physician groups to advocate on behalf of cardiologists.