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| RACs: Strategies to Reduce Your Risk and Successfully Appeal Payment Denials |
As the permanent recovery audit contractor program gets under way, you need details on areas ripe for review and strategies on how to effectively appeal RAC payment denials.
RACs: Strategies to Reduce Your Risk and Successfully Appeal Payment Denials is filled with articles and illustrations — including CMS data, a sample audit plan and the complete presentation from a recent AIS audioconference on this topic — 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
National RAC Rollout
- RACs Identify $1 Billion in Payment Errors; CMS Applies Lessons to National Program
- No More RAC Audits, Recoupment Without CMS OK; Rollout Begins as Vendors Named
- CMS Guidance Bars Rebilling Under RACs, But Alternate Route to Payment May Exist
- RACs Are Back as Protest Is Settled; Judges May Reject CMS Rebilling Ban
- Egged On by Contingency Payments, RACs May Extrapolate Overpayment Findings
- Conflicting Guidance About MD Signatures On Orders Creates a Quandary for Hospitals
- CMS: Providers Will Face Only Automated Reviews as Permanent RACs Get Feet Wet
Facing RACs: Strategies for Success
- RAC Denials for Unnecessary Admissions Are Overturned; Process Is Questioned
- Preventing, Overturning RAC Denials for Unnecessary Admissions
- With RAC Appeals Bigger Part of Medicare Landscape, Consider Potential Strategies
- Appealing Recovery Audit Contractor (RAC) Denials
- With Hospital Rebilling Limited Under RACs, Presubmission Review Becomes More Vital
- Fine’s Criteria for Pneumonia May Fend Off Admission Medical-Necessity Denials
- RAC Fears May Spur ‘Defensive Coding,’ Creating Payment, Compliance Risks
RAC High-Risk and Target Areas
- Respiratory Diagnosis Coding Is a Top Error; Documentation Clarity Needed Among MDs
- Hospitals May Have Risk in Fine Line Between Admission, Observation
- Consider Creative Ways to Challenge RACs As Debridement Becomes a Likely Target
- Spine Pain Treatment Attracts OIG Scrutiny, Is Ripe for Internal Audit
- With RACs Hot for Excisional Debridement, Review Bedside Documentation, DRG Impact
The Recovery Audit Contractor (RAC) Initiative: Looking Forward (presentation by Diane Cahalan and Lawrence Vernaglia)
Written
By
This book was written by the editorial staff of AIS, and includes a presentation by Diane Cahalan, a director in PricewaterhouseCoopers LLP’s (PwC) Health Industries Advisory Practice, and Lawrence Vernaglia, a partner with Foley & Lardner LLP.
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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