Here are just a few of the articles we’re prepping today for Thursday.
RACs’ Strengths and Weaknesses Versus Providers: Who’s Winning at Mid-Year?
We set the stage with an excellent article from Bret S. Bissey, FACHE, MBA, CHC. Bissey will take you through SWOT (Strength/Weakness/Opportunities/Threats) analysis of RACs versus providers. His warning for providers:
The most significant economic downturn in a generation is causing financial calamity within many hospitals around the country. There is hardly enough money in hospitals to fund necessary capital expansion, purchase state-of-the-art equipment, support IT or building infrastructure, pay vendors and meet payroll. Thus the challenge for many hospitals to hire dedicated RAC coordinators, have physicians appropriately educated, staff knowledgeable personnel and perform all of the necessary preventative RAC efforts is very daunting.
Bissey adds: The primary way to determine if you have risk connected to complex reviews is to perform chart reviews that compare the documentation of a service to what has been billed and paid for by your fiscal intermediary.
Raking Providers Over A Financial Fire
As summer approaches, Margaret Klasa, Board Certified DC and APRN will talk about a different kind of heat, admonishing CFOs, CIOs and HIM directors to investigate their existing technology potential within their current Practice Management Systems (PMS), claims editing software and EHR systems by re-examining workflows from registration through claims submission to ensure that documentation, medical necessity and numerous other issues identified in the RAC demonstration program are addressed.
She will tell you that investing in RAC tracking software will help hospitals that are most likely to be inundated with numerous medical record requests for the complex RAC reviews. No longer can a provider’s internal audit team rely on spreadsheets to capture, track and update the vast amount of data required by the RAC program and allow easy accessibility to other members.
The Role Physicians Play in RAC Preparation
Sandra M. Miller suggests “you may be wondering how to ensure physician documentation translates into proper coding in the billing cycle. You also may be wondering how to go about discussing improving documentation with the physicians who practice at your facility.” Dr. Miller will tell you the importance, now more than ever, that providers establish those lines of communication by working together to assess documentation risk areas and install processes and procedures to ensure claims are not denied due to improper documentation or lack of documentation.
Also this week, you’ll hear from George L. Kelley, MS, MBSA, and editorial board members Patricia Dear and Leo Paul D’Orazio, MBA, FACHE.
It’s starting to heat up. Check us out on Thursday and discover why RACMonitor is the single most important source of RAC news and information.