A third of the reimbursements collected in the demo phase of RAC were due to "wrong setting" denials, according to the Center for Medicare & Medicaid Services. This type of denial denotes hospitals that have provided patients with unnecessary care, mainly for keeping patients for overnight care when it was unnecessary. As we embark on a new year, financial leaders should ask everyone on their teams to make a resolution to address these problems before the RAC does it for them.
To help in this effort, I touched based with Karen Bowden, president of ClaimTrust, a Murfreesboro, TN-based consulting firm, which has worked with several hospitals in the demonstration project to develop RAC-proof admission screening criteria.
With the goal of ensuring consistent admission screening among patients, Bowden suggests hospitals begin by adding the following screening criteria: