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Back to Basics: Why are the RACs here?

Wednesday, April 28, 2010

3:00 - 4:00 PM Eastern
2:00 - 3:00 PM Central
1:00 - 2:00 PM Mountain
12:00 - 1:00 PM Pacific

Duration: 60 Minutes

Cost: $99.00

Order Recording

Overview

Clinicians are not Medicare reimbursement gurus, nor should they be. However all staff involved in documenting patient services should have a basic understanding of Medicare reimbursement and how documentation impacts the hospital's ability to receive payments. Recovery Audit Contractors (RACs) are comparing the diagnostic and procedural information on the claim form to the documentation in the beneficiary's medical record. Insufficient documentation often results in a denial of payment for the service. This presentation will provide an overview of Medicare reimbursement and the documentation areas targeted by the RACs.

The goal of this presentation is to provide information to hospital staff which can result in more accurate documentation of services performed and fewer RAC denials.

Topics covered:

• Medical record documentation
• Diagnoses and procedure code assignments
• DRG / APC / CAH payments
• The RAC focus
• DRG validations/MCCs/CCs
• Medical necessity

This presentation is targeted toward staff members who are involved in the documentation of patient services and/or the billing of Medicare claims. It will also be of interest to staff interested in understanding why the RACs are targeting certain claims for review.