May

13

Prepare case managers for RACs

By Case Management Weekly

CMS’ RAC project has made it necessary for case managers to become as knowledgeable as possible about denials and appeals. What do you need to do to be prepared for the RAC in your state? Here is a checklist to help you:

• Form a RAC committee in your facility. Include a medical advisor and representatives from finance, compliance, billing, and admitting. This committee should be a clearinghouse and review center for all RAC-related activities, including preparing for audits and understanding and determining vulnerabilities.
• Perform an internal audit of improper payments. Use findings from the RAC demonstration to help you prepare and identify the areas of vulnerability in your facility by visiting www.cms.hhs.gov/rac.
• Conduct a medical records audit of short stays. Examining your one- to two-day stays will help you gain an understanding of prior and present cases, as will the use of standardized clinical leveling criteria to establish the medical necessity of each case.

Check out the May 2009 issue of Case Management Monthly to read the full story.