Audits can be done at any time to verify tax claims.
Preparing for Recovery Audit Contractor (RAC) Program audits requires much planning and organization. The Centers for Medicare and Medicaid Services decide the dates of RAC audits. Audits can be requested at any time. Getting the right things in order can make the process easy and straightforward, preventing fines or fees from being incurred.
Instructions
1. Create a team of representatives from the compliance, financial services and finance departments, as well as the office of general counsel and the health information management team. Establish a team leader who maintains a neutral stance within the organization and is respected by the main people involved in the preparation of materials. They should have a broad range of knowledge of internal and external review processes, think strategically and be able to communicate professionally.
2. Educate and inform the senior leaders within the organization about the results of a thorough external investigation of documentation practices, coding accuracy and the medical necessity of discharges, both past and present. Thoroughly review a one-day stay and the proper assignment of observation status to complete the initial assessment of the organization's risks.
3. Work together with physician champions to improve procedures and the documentation of diagnoses and medical necessity. Allowing these professionals to support development and implementation of the RAC program can help you avoid costly fines from an audit.
4. Learn the appeals process. Creating and implementing procedures and policies for the established appeals process is a valuable and critical aspect of preparing for the RAC audit. The appeals process has five levels: redetermination, reconsideration, administrative law judge hearing, Medicare Appeals Council and judicial review in a U.S. District Court.
Tags: appeals process, medical necessity, within organization