New Connolly RAC Issues March 2011

on Thursday, 31 March 2011. All News Items

Connolly Healthcare, the RAC contractor for Region C which includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, and West Virginia, has recently posted two new outpatient issues and one expansive inpatient issue to their website. The inpatient issue has a number of new twists:

  • It contains the largest number of codes ever combined into one issue by Connolly;
  • It adds several DRGs for inpatient medical necessity reviews and numerous DRGs for DRG validation; and
  • It includes, for the first time, ICD-9-CM diagnosis codes for DRG validation.

MMP, Inc. received confirmation from Connolly that claims with any of the listed DRGs are subject to review and claims with any of the listed diagnosis codes as a principal or secondary diagnosis are subject to review.

MMP, Inc. notes that a number of the MS-DRGs listed as approved for DRG validation review in this issue are not valid MS-DRGs. MMP has submitted an inquiry to Connolly concerning this. We will provide an update when available.

As always, MMP retainer clients can view lists of all the Connolly RAC issues on the Resource page of our website ( Lists are separated into 1) DRG Validation issues, 2) Inpatient Medical Necessity issues, 3) Outpatient issues, and 4) Other Inpatient issues. Features of the lists that make it easier to navigate the RAC issues include:

  • Inpatient issues sorted by MS-DRG;
  • Full DRG, ICD-9-CM diagnosis code, and outpatient issue descriptions;
  • Associated CPT codes for outpatient issues;
  • Associated DRGs for ICD-9-CM diagnosis codes;
  • Issue publication date;
  • New issues highlighted; and
  • Frequent updates.

Providers can also keep up with the issues on the Connolly Healthcare website.

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