Revised RAC statement of work: Impact on providers
Medicare Update for CAHs, October 5, 2011
Among the areas of potential interest for providers, the newly released guidance addressed the RACs’ treatment of the discussion period, according to Michael Taylor, MD, vice president of clinical operations at Executive Health Resources in Newtown Square, PA.
“When the discussion period first rolled out, CMS and the RAC contractors were heavily promoting it. It could be done in a verbal format, but now, it is clear that the discussion period has to be in a written format. If the provider is pursuing discussion, and an appeal is filed during that time period, the RAC is charged—at that point—with ending the discussion period,” says Taylor.
He continues, “So providers are going to have to make the choice of going right into the appeals process or using the discussion period first, because providers could find it fruitless to do this at the same time because of the new policy.”
With this new change, providers will have to take more of a targeted approach. If a provider seeks to appeal early in the process to prevent recoupment, managing timelines becomes crucial. Depending on the timeliness of correspondence with the RACs, providers may opt not to use the discussion period because it may slow their process down and it could put their ability to file that first level appeal in time to prevent recoupment in jeopardy, according to Taylor.
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
-
- CMS seeks comment on quality measures
- Practice the six rights of medication administration
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Nursing responsibilities for managing pain
- CMS creates web portal for questions about 1135 waivers, PHE
- Q&A: Primary, principal, and secondary diagnoses
- OB services: Coding inside and outside of the package
- ICD-10-CM coma, stroke codes require more specific documentation
- The consequences of an incomplete medical record
- E-mailed
-
- Coronavirus vaccination: 4 best practices for communicating with patients
- Q&A: Pressure ulcer POA code confusion resolved
- Neurological checks for head injuries
- Keyes Q&A: Generator lighting, fire dampers, eyewash stations, ISLM fire drills
- Including 46600 in E/M leveling systems
- How to get reimbursed for restorative nursing
- Fetal non-stress tests represent important part of maternal and fetal health
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Know how to correctly code each procedure an otolaryngologist can perform on turbinates
- Coding Clinic reiterates guidelines for provider documentation
- Searched