Assessing and quantifying your risk for RAC recoupments
Recovery Auditor Report, September 8, 2011
Editor’s note: This article was excerpted from the new HCPro book, “The RAC Toolkit for Hospitals and Health Systems,” by Amanda W. Berglund, MS, MBA and Elizabeth E. Lamkin, MHA. Lamkin will be signing copies of the book at HCPro’s Medicare Compliance Forum, which takes place September 19 and 20 in Chicago.
The purpose of the book is not to highlight every issue that RAC will consider for overpayment, but to arm providers with tools to assess their own organization’s systems and processes and to mitigate the loss of revenue and risk of overpayments. It is the responsibility of the RAC committee to stay on top of all issues approved for their regional RAC.
To take a proactive approach to the RAC process, you will need to assess your current level of financial risk. You can do this internally or with the help of external resources. There are many good risk-evaluation software tools on the market for hospitals and health systems, and there are also consultants who specialize in reviewing hospitals’ claims for proper coding and documentation to assess overall compliance risk and make suggestions for corrections. Once you identify and quantify your risk, you can begin to take action to mitigate the impact of a RAC audit of past claims and to improve your systems to avoid being out of compliance in the future.
Related Products
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
Combat RAC Denials: Strategies for Successful Appeals
During this 90-minute audio conference, our speakers provide step-by-step procedures, timelines, tools, and best practices...
-
The 2013 Medicare Compliance Forum: Las Vegas, NV
-
Level of Care Determinations for 2014: Las Vegas, NV
Attend the half-day seminar, Outpatient, Observation or Inpatient? Continuing to Walk the Tightrope of Regulatory Guidance...
-
OPPS and IPPS Reimbursement Fundamentals: Las Vegas, NV
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on October 2nd in Las Vegas. Learn how CMS’ substantial...
Most Popular
- Articles
-
- Use caution when applying modifier -25
- Don't forget the three checks in medication administration
- Nursing responsibilities for managing pain
- Steps for maintaining patient privacy
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Practice the six rights of medication administration
- Poor documentation: The consequences
- Note similarities and differences between HCPCS, CPT® codes
- Complications from immobility by body system
- Q&A: Primary, principal, and secondary diagnoses
- E-mailed
-
- Understand how to apply the 1995 and 1997 Documentation Guidelines for E/M Services
- Tip: Identify covered nerve block procedures
- Putting Management and Evaluation into Perspective
- OB services: Coding inside and outside of the package
- Learning and mastering the operating budget
- CAHs and condition code 44
- 10 Tips for Educating Elderly Patients
- Searched