Health Information Management

Tip: Get your documentation 'RAC ready'

APCs Insider, December 31, 2010

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If you aren’t preparing for the RACs now, you should be. Although much attention is being given to their focus on diagnosis-related groups (DRG) validation and other inpatient audits, outpatient facilities and physician practices should not overlook the importance of RAC preparation.

Physician offices and outpatient facilities should begin reviewing documentation to ensure it will pass muster once RAC requests start arriving. Often, documentation fails to meet Medicare guidelines.
Physicians and facilities sometimes overlook even the basics, so be certain that you and your physicians know:

  • What documentation constitutes a complete history
  • Which exam elements are required for a comprehensive exam
  • What CMS means by “medical necessity”
     

RACs already are reviewing medical necessity in the hospital setting. They also are comparing what a hospital reports on a claim with what physicians report. RACs are reviewing everything from ICD-9-CM coding to date of discharge—and they are looking for those claims to match.

This tip was adapted from “RAC audits are not just an inpatient issue” in the December issue of Briefings on APCs.



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