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Be part of RAC defense on front end

Patient Financial Services Weekly Advisor, December 19, 2008

Patient access departments play an important role in protecting the hospital's reimbursement for cases that are reviewed by the Recovery Audit Contractors (RACs). And as a patient financial services manager, you must work with the front end daily.

Use the holiday season to provide a review session for all patient access registrars by reviewing a sample of physician orders to ensure that the physician specifically states "admit as inpatient" or "admit for observation services." Do not assume that the word "admit" means an admission to an inpatient bed.

For orders written for observation services, the orders must be dated, timed, and signed, and include a clinical reason for being admitted to observation. If the reason is lacking, call the physician's office for this information. If the clinical reason is not clear, refer the order to your Utilization Review/Case Management liaison.

Editor’s note: These tips were submitted by Rose T. Dunn, RHIA, CPA, FACHE chief operating officer of First Class Solutions, Inc., in Maryland Heights, MO.

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