| RACs: Strategies to Reduce Your Risk and Successfully Appeal Payment Denials |
While CMS’s Recovery Audit Contractor (RAC) program expands to include audits of Medicaid claims, as mandated in the federal health reform law, you need details about current RAC targets and those likely in the future, as well as strategies on how to respond.
RACs: Strategies to Reduce Your Risk and Successfully Appeal Payment Denials is filled with articles and illustrations — including CMS data and sample forms — on tactics that have been used with success to reverse unfavorable outcomes and to prevent future risk exposure.
Learn the keys to success, including:
- How to prepare for a RAC audit and identify potential risk areas in your organization.
- Best-practice strategies to establish processes for records requests and appeals.
- Which risk areas RACs are expected to target nationwide.
- Updates on the latest changes to laws related to Medicare overpayments.
Get the guidance you need on auditing and evaluating particular areas before the RACs do. Order RACs: Strategies to Reduce Your Risk and Successfully Appeal Payment Denials today!
Table
of Contents
High-Risk and Target Areas
- CMS Official: Site-of-Service Errors Are Top Risk; Expect Cardiac Status Guidelines
- CMS: Half of Medicaid Audits Hit Hospitals; QIO Admission Necessity Can Be Overruled
- OIG Data Reveal Excessive Billing for Services Done by Unqualified Nonphysicians
- Interventional Radiology Errors Are Pervasive, May Attract RAC, MAC Scrutiny
- RACs Focus on Riskiest Services, but Hospitals Should ID Their Vulnerabilities
- CMS Revises RAC Medical Records Cap; RACs Can Target One Area
Facing RACs: Strategies for Success
- RAC Flow Charts Drive Coordination Among Relevant Departments
- Work Flow Process for Recovery Audit Contractor (RAC) — Complex Reviews.
- How to Challenge Claims That Are Denied By CMS for Insufficient Documentation
- Hospitals Should Utilize Their In-House Data to Fight Auditors’ Fire With Fire
- Working Outpatient Code Edits to Improve Compliance
- Adopting the Same Admission Criteria as RACs Is Expensive and Not Necessary
- More Payers and Auditors Are Accepting Documentation from Non-Physicians
- Compliance Workload, Responsibility Grow With Heightened Enforcement
- Form for Tracking Internal Compliance Requests
- Service Request Summary Report
- Confusion Over Gastroenterology Coding Surfaces During Audits
- RAC Reviewers Hit Hard on Debridement; Five Elements Must Be Documented
- Improving the Query Process for Debridement
- Hospitals Face Medical-Necessity Denials Despite Getting Green Light From InterQual
- Hospitals Grapple With DRG Bundling of Nondiagnostic Services; Policy May Change
- RACs Are Requesting Physician Queries; CMS Says Their Submission Is Not Required
Looking Forward: RAC Trends
- Enforcers Have More Funds, Better Tools to Fight Overpayments, Fraud
- Reform Law Requires Overpayment Returns, Compliance Programs for All Providers
Written
By
This book was written by the editorial staff of AIS.
Written
For
Compliance officers; attorneys; and financial and operations executives at
- Hospitals
- Health systems
- Medical group practices
- Consulting firms
- Law offices
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Related
Publications
Report on Medicare Compliance
High-Risk Areas in Medicare Billing
The HCCA-AIS Medicaid Compliance News
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