Health Information Management

RAC report casts spotlight on wrong-setting errors

Briefings on APCs, June 1, 2008

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Examples of recouped payments for outpatient services also detailed in report

Editor’s note: The first article in this two-part series appeared in the May BAPCs. It discussed ways that your facility can prepare for audit under the recovery audit contractor (RAC) program.

RACs have collected huge sums simply by comparing one-day stays with InterQual criteria, a set of measurable clinical indicators that reflect a patient’s need for hospitalization, says Marion Kruse, RN, MBA, a consultant at FTI Consulting in Atlanta. When these stays did not meet InterQual guidelines, RACs requested a repayment.

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