RAC Focus: Claims Review Targets

In this course the student will learn which elements of the UB-04 and the CMS-1500 Forms may be identifying the organization for additional scrutiny by reviewers. This session will analyze both the CMS-1500 and the UB-04 claim forms and identify key data elements that cause RAC and other reviewers to sit up and take notice or call for immediate recoupment upon review of providers’ claims.

This course authored by Paula Digby.

Course Objectives:

  • Understand the importance of correct data on your claims.
  • Identify specific claim elements that should be reviewed by billing staff BEFORE claims are submitted and why.
  • Identify ways to optimize your claims and suffer fewer denials from RACs and other CMS contractors.

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