Revenue Cycle

RACs deny post-discharge queries

Recovery Auditor Report, August 5, 2010

The provider community is reporting a new trend of late: RACs are denying post-discharge queries despite published guidance which states that this is an allowable practice.

In October 2008, the American Health Information Management Association (AHIMA) published the article “Managing an Effective Query Process,” which states that retrospective queries are permissible and are “effective in cases where additional information is available in the health record, in short stays where concurrent review was not complete, or whenever a concurrent query process is not feasible.”

Despite the AHIMA guidelines, providers are seeing cases with retrospective queries being denied as a result of the RAC’s individual policy. Sarah Shaver, RHIA, CCS, RAC coordinator at Moses Cone Health System in Greensboro, NC, provides an example.

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