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CMS OKs 'Medical Necessity' Reviews for RAC

James Carroll, for HealthLeaders Media, August 12, 2010

It is hoped that hospitals have been heeding the advice to prepare for the medical necessity phase of the permanent RAC program, but if they haven't, they certainly can't put it off any longer, said Tanja Twist, MBA, HCM, director of patient financial services at Methodist Hospital of Southern California in Arcadia, CA.

Among the critical items facilities must be prepare for, Twist said, are:

 

  • Additional RAC record pull requests
  • Setting up side-by-side review teams to evaluate the stability of the records being requested
  • Whether or not to appeal cases where a determination has been received
  • Reconvening RAC team meetings
  • Fine-tuning the tracking system
  • Monitoring the RAC website every day for activity.

    "The industry simply can't afford to bury its head in the sand any longer," says Twist. "The RACs are coming."

    View the AHA news release here.

    Stay on top of the latest RAC developments here.

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    James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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