The RAC Survival Guide
Individual hospitals have already lost millions of dollars through RAC audits.
How much does your hospital stand to lose?
The RAC Survival Guide: Successful Management of Recovery Audit Contractors is a comprehensive resource that will help you navigate the complex RAC process from beginning to end.
Author Kimberly Anderwood Hoy explains the truth and dispels the myths about the RAC program and explains what you need to do to survive RAC audits, master the appeals process, and manage resources with minimal impact on operations.
RACs are targeting high dollar inpatient cases. With more money at stake and a convoluted appeals process to navigate to keep your money, the RACs are counting on you not being prepared. It’s not enough to ensure you provided covered care, you must know how to defend your right to payment.
This book delivers expertly developed solutions, practical steps, and hands-on tools in easy-to-understand language. It will be a well-used resource for every member of your RAC team.
The RAC Survival Guide will help you:
- Prevent potential financial losses caused by disruption to your cash flow
- Form a collaborative, multidisciplinary RAC evaluation and response team
- Respond to RAC notification letters and appeal claims
- Assemble the information and documentation necessary to respond to a RAC request
- Understand the complexities of the RAC process and its potential ramifications for other CMS audits
- Understand the five levels of appeal and how to manage each one:
- Administrative Law Judge
- Medicare Appeals Court
- Federal District Court
Your copy includes:
- Guidelines for responding to RAC auditors
- Suggestions to form a RAC response team
- Detailed tool to understand the complex appeals process
- Guidelines for developing:
- A strong utilization review plan and committee
- Solid policies for inpatient, outpatient, and observation admissions
- Outpatient documentation policies to ensure proper physician supervision and coding
Meet the author:
Kimberly Anderwood Hoy, JD, CPC, is the director of Medicare and Compliance for HCPro. She is the lead instructor for the Medicare Boot Camp®—Hospital Version and serves as the manager overseeing HCPro’s Medicare Boot Camps. She is a consultant for HCPro’s Revenue Cycle Institute, specializing in regulatory guidance on coverage, billing and reimbursement. She has expertise in charge description master operation, development, and maintenance and experience conducting billing compliance audits and internal investigations. She serves as a frequent expert on HCPro audio conferences and has served as a speaker at national conferences on patient status and observation.
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