Health Information Management

Tip: Reduce RAC denials with targeted auditing

HIM-HIPAA Insider, July 27, 2010

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Providers can make a great impact in terms of reducing RAC denials at their facilities with effective auditing, according to Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City. Levitt spoke during the April 29 HCPro audio conference, “RAC Complex Coding and DRG Targets: Prevent Errors and Reduce Denials.”

When auditing DRGs, Levitt suggested reviewing charts for the following: 
  • Lack of coding specificity
  • Sequencing errors with ICD-9 codes
  • Incorrect code combinations
  • Failure to assign multiple codes when appropriate
  • Nonspecific signs and symptoms
  • Use of complication codes
  • Supporting documentation for procedures
  • Supporting documentation for complications and comorbiditys (CC) and major CCs 
  • Supporting documentation for charges
In addition, make sure to review your RAC’s list of DRG audit issues against your DRG data. “Put your overall risk into perspective,” Levitt said. “You need to know your facility’s weak areas and work on them with your RAC and HIM teams.”
 
Editor’s note: For more tips, view the full article on the HCPro website. Medical Records Briefing subscribers have access to the article in the July issue of the newsletter.



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