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Services: Recovery Audit Contractors (RAC)
The RAC program mandated by the Tax Relief and Health Care Act of 2006 will
roll-out nationwide no later than January 1, 2010. It is anticipated that Ohio
will be one of the last states in Region B to "roll-out" the program.
In anticipation of the RAC program, QMCG offers audits and/or educational
programs to prepare your facility for the permanent RAC program and identify
how your facility currently complies with coding and billing regulations,
before the RAC is initiated in Ohio. The look back date for the RAC is claims
processed as of October 1, 2007 so auditing now to identify any suspected
problematic areas is in your facility's best interest!
Some RAC services offered by QMCG:
Education:
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To hospital staff: on the permanent RAC program
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To physicians: on the RAC permanent program and how this will
affect their practice, as well as the hospital;
Audit:
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Inpatient: an audit is conducted for high risk DRG/MS-DRGs and
the coding for excisional debridement
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Outpatient: an audit is conducted for certain high risk
outpatient services to determine coding and billing accuracy
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Short Inpatient Stays: an audit is conducted on accounts with a
1-3 day inpatient stay to determine if the inpatient stay was medically
necessary
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Inpatient Rehabilitation: an audit is conducted to determine if
inpatient rehabilitation was the most appropriate setting, especially in cases
when a single joint replacement has recently been done in an acute care
hospital
The education and audit services are conducted according to the specific needs
of your facility. Contact Charlene
Nutter at cnutter@qmcg.com for
more detailed information on the RAC.
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