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CMW Tip of the Week: Address one-day stays before the RAC permanent program begins

Case Management Weekly, February 18, 2009

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It is no secret that RACs focused on one-day stays in the demonstration project. So what are you doing in your organization to address status compliance before the permanent RAC program goes live?
 
If you haven’t done much, or are still looking for other ways to help ensure your organization’s compliance, consider the following strategies that hospitals have deployed to address one-day stay and medical necessity compliance:

• Have an admission (emergency department, recovery room, and direct admission) care manager to assist physicians with appropriate status assignment
• Have a physician advisor (often outsourced) be readily available to assist a care manager with a review requiring medical judgment

Without prompt and deliberate reviews for medical necessity, over or under-utilization of observation may result. Over-utilization often results in loss of revenue while under-utilization often presents noncompliance.
 
Perform internal concurrent audits within your organization and identify your barriers for compliance. Now is the time to build a program to address appropriate status assignment.
 
Editor’s note: Yvonne Focke, RN , BSN , MBA, director of revenue cycle management at St. Elizabeth and St. Luke Hospitals in Northern Kentucky provided this tip. Focke will be giving an in-depth presentation on one-day stay compliance during the presentation “Monitor one-day stays under RAC scrutiny,” at HCPro’s Recovery Audit Contractor Defense: A RAC Readiness Summit conference next month in Phoenix.

Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!

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