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Tip: Hire a physician liaison to jump-start your RAC efforts

Recovery Auditor Report, January 8, 2009

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by Glenn Krauss, RHIA, CCS, CCS-P, CPUR

One item that appears to be missing from most HIM directors’ RAC preparation checklist is a root-cause analysis of the contributing factors to RAC denials (i.e., whether they are rooted in medical necessity, coding, or both).

Although some argue that RACs arbitrarily deny clinical cases with little appreciation of clinical standards of medicine and evidence-based medicine, it can certainly be said that hospitals contribute to self-inflicted denials through woefully inadequate patterns of nursing and physician clinical documentation. This inadequate documentation begins in the ER and pervades the patient’s entire visit. Instituting a RAC response infrastructure that includes a root-cause analysis is essential.

Using a physician liaison in the coding and case management/utilization review process first became popular during the 1990s, as hospitals quickly recognized the direct benefits of a properly structured physician liaison program.

However, with time, the merits and value of such a program fell out of favor primarily due to budget cuts and fewer hospital dollars available for discretionary programs or initiatives. Today, however, physician liaisons are back on the scene and more important than ever.

A well-trained physician liaison is instrumental in not only developing action plans to address process deficiencies, but he or she can also implement these deficiencies in an effective and efficient manner.

An effective physician liaison can provide education, instruction, and training to physicians about their role in consistently demonstrating medical necessity through succinct medical record documentation.

Editor’s note: Krauss is a senior coding and chargemaster consultant for QHR in Brentwood, TN. This tip was excerpted from the January 2009 issue of the HCPro, Inc., newsletter Medical Records Briefing.

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