A RAC Monitor article includes four key points for providers to understand aboutSupplemental Medical Review Contractors in the year ahead.

Outpatient procedures and ancillary testing often are overlooked by other contractors, but again, the SMRCs have a more focused approach to claim review. Sleep apnea testing is one such type of audit. Concern about this growing field of ancillary testing triggered an OIG study and summary report in October 2013 titled “Questionable Billing for Polysomnography Services.” According to the study’s executive summary, “increased Medicare spending on polysomnography (a type of sleep study), along with growing concerns about fraud and abuse, prompted OIG to conduct this study.” SMRC auditing of polysomnography services is just one example of stronger analytics in action.