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Regulatory MonitoringOct
28
CMW sneak peek: The RAC effect: How RACs influence case management
By
By Loretta Sandy, PhD, RN, CCM
One of the primary rules physicians and nurses learn in school is "if it is not documented, it is not done." Another concern expressed by medical professionals in our litigious society is "remember that you may need to defend what you charted in a court of law." Finally, attorneys caution healthcare professionals that the more they chart, the more they may have to defend.
Although these statements are not contradictory, healthcare professionals are typically cautious. However, with the implementation of RAC audits, documentation must be comprehensive because it helps ensure that hospitals receive fair and justifiable reimbursement.
Given the potential effects of a RAC audit, healthcare professionals must understand why they should carefully document the following:
- Presenting symptoms
- Rationale for a particular level of care
- Treatments provided to improve a patient’s clinical status
Healthcare professionals must also substantiate their clinical judgment as to why a patient needs to remain in a given level of care on a daily basis. The case manager should confirm that the documentation is accurate and consistent with the hospital’s level-of-care criteria (e.g., Milliman, Interqual). If clinical documentation is not consistent with screening criteria, it must define the rationale for treatment decisions.
Check out the November 2009 issue of Case Management Monthly to read the other creative ways to reduce LOS. You can also discover the benefits of becoming a Case Management Monthly subscriber.
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