Recovery Auditor Prepayment Review Demo Still Pending
Despite this fact, if providers have not already begun doing so, they should take action, according to Sharon Easterling, MHA, RHIA, CCS, CDIP, CEO of Recovery Analytics in Charlotte, N.C.
"With the shift of the RAC to up-front documentation review, providers should implement concurrent processes in their case management and utilization review areas," she says. "From there, you should have second level review done by a physician for these particular DRGs."
"Facilities may also want to consider educating their physicians on these particular DRGs to identify key documentation points that help to meet medical necessity," she continued.
When it comes to physician education, all doctors are different, and some are more receptive than others. In situations where it requires a bit more effort, Easterling suggests using a physician advisor.
"Having a physician that speaks with the other physicians about the required documentation for medical necessity—and the translation of that information—is very important."
- How Top-Ranked MA Plans Earn Their Stars
- WellPoint Dominates Nearly Half of Markets, AMA Says
- CMS Offers Some ACOs $114M for 'Upfront' Costs
- Ebola: Second TX Nurse Diagnosed After Improper Protective Gear Application
- How Hospitals Can Become 'Upstreamists'
- Providers Ask HHS to Address EHR Interoperability Barriers
- 16 Medicare Advantage Plans Earn 5-Star Ratings
- The Drug Price Reform Debate
- Ebola: A Call for Designated Hospitals
- CMS' new investment model will help ACOs with health IT