Inpatient admissions among top RAC targets
Inpatient admissions among top RAC targets
To minimize damage from RAC audits, risk managers should make sure their facilities have highly competent case managers available seven days per week, advises Bill Hammock, RN, BSN, CMC, ACM, vice president and senior consultant in the Global Clinical Health Care Consulting Practice of Marsh in Nashville, TN.
Those case managers must ensure that their case management function includes preadmission review and effective gatekeeping, he says. They have the ability to prevent some of the more common errors that are discovered in RAC audits.
Hammock says these are some of the top sources of RAC-initiated overpayment collections:
Inpatient admissions for procedures that do not require the inpatient setting.
One- and two-day stays that do not qualify for admission.
Three-day stays solely to qualify for skilled nursing facility admission.
Inpatient rehabilitation when the service is not medically necessary.
Coding errors.
With those common problems in mind, Hammock says hospitals should assess internal control systems, such as case management, gatekeeping and audits, including coding, financial, and compliance audits. They also should educate stakeholders, including the RAC team, governing body, leadership, physicians, and department heads. And they must assess financial risk and calculate necessary financial reserves based on internal audit and look-back period exposure, he says.
Source
For more information on preparing for RAC audits, contact:
Bill Hammock, RN, BSN, CMC, ACM, Vice President and Senior Consultant, Global Clinical Health Care Consulting Practice, Marsh, Nashville, TN. Telephone: (615) 340-2409.
To minimize damage from RAC audits, risk managers should make sure their facilities have highly competent case managers available seven days per week, advises Bill Hammock, RN, BSN, CMC, ACM, vice president and senior consultant in the Global Clinical Health Care Consulting Practice of Marsh in Nashville, TN.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.