“Finally Friday!” The Return of “Reach-Thru” or “Shadow” Denials – Transmittal 534

Transmittal 505 Resurrected as 534
“Reach-Thru” Denials Are Back

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The Elephant in the Room: What will the RAC do with all this?

The Elephant in the Room: What will the RAC do with all this?

This week, we looked at the newest wrinkle in what has been termed, “Reach-Thru Denials” and the latest version of a CMS rule that now will “…allow the MAC and ZPIC to have the discretion to deny other “related” claims submitted before or after the claim in question.

According to CMS, “…if documentation associated with one claim can be used to validate another claim, those claims may be considered “related…

Effectively, as of Sept. 8, 2014, the door has been opened for the contractor to deny the physician bill, perhaps even without issuing an Additional Documentation Request (ADR) for the physician’s records. Maybe. It’s a big question. And really, there’s still a LOT of questions… but as usual, we hope to bring together some of the best thought leaders and help you get out in front of all this.

So here’s what we talked about on the show:

  • How Did We Get Here?  – Brief history of the relevant Transmittals, 505 & 534;
  • What Do You Tell Your C-Suite?Dr. Salvatore‘s nice slides from his own presentation to his hospital’s Executive Committee;
  • Dr. Steve Meyerson reviews a few of the Slides for us, since Dr. Salvatore could not join us, and he had advised Dr. Salvatore on the presentation;
  • What Should YOU Watch Out For Now?Day Egusquiza gives her insights for revenue cycle professionals;
  • The Legal PerspectiveJessica Gustafson and Abby Pendleton gave the lawyers’ viewpoint, and what they have already been seeing from the contractors;
  • The Elephant in the Room – What will the RAC do in all this? No one can really say at this point, but we do mention what we think will happen…

Also, joining us this week was my co-host, Bill Malm, our Audit expert, giving us a sense of what he’s been hearing from the auditor community.

Video Replay & Handouts

This week’s handouts included:

CMS Transmittal 534
CMS Transmittal 505
Dr. Salvatore’s Executive Presentation [SLIDES]
Dr. Salvatore’s Physician Presentation [Word doc]

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