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RAC readiness hinges on medical necessity reviews: brief delay in audits lets hospitals refine documentation and coding processes.

Publication: H&HN
Publication Date: 01-JUL-09 		Format: Online
Delivery: Immediate Online Access

Article Excerpt
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Hospitals breathed a sigh of relief in early June when the government announced that Recovery Audit Contractors would not begin their complex audits into medical necessity at least until 2010.

That buys hospitals more time to tweak their documentation and coding processes, assess their weaknesses and train their staffs, says American Hospital Association Vice President of Policy Don May. The postponement also allows the Centers for Medicare & Medicaid Services and the RACs to work out the kinks in their programs.

"It gives time for CMS to evaluate the proposals the RACs have put together for doing medical necessity reviews. Hopefully, they'll take the time to do some heavy-duty screening and ask them to explain how they plan to manage the process and how they'll apply the criteria and really run them through the traps," May says.

In 2005, CMS launched a...

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