Revenue Cycle

Focus on prevention of future recoupments

Recovery Auditor Report, June 2, 2011

The long-term goal for every facility facing RAC should be to avoid RAC recoupments by ensuring proper billing compliance. A preventive system, as opposed to a reactive one, shifts resources—specifically full-time employees (FTE), in this case—from the back end of the process where staff struggle to deal with errors leading to bill holds, rebilling, coding problems, and denials, to the frontend of the process where staff are focused on preventing errors in the first place through proper and appropriate registration, bed status, and documentation.

 In an article describing the need for the CDIS role, Dr. Paul Weygandt points out that “analysis often begins with the review of a near miss or adverse event. The challenge, and missed opportunity, has been to develop an approach to proactively and prospectively coordinate care in such a way that near misses and adverse events do not occur in the first place.”

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