HIPAA “minimum necessary” - Health Care Compliance Association

Code RAC: Is your hospital response team ready?...continued from page 27Category – A category allows an end user who is not familiar with theentire RAC process to see a narrative description of the RAC stage foreach group of accounts. These categories are useful when analyzingfinancial activity for groups of accounts.Color Code Description CategoryPale Green 0 BeingReviewedYellow 1 Will notappealPink 2 PossibleAppealRecord sent,awaiting RACdecisionRecord sent andhospital agrees withdecisionRecord submittedand hospitalreviewing forappeal decisionPurple 3 Appealed Record submittedand appeal sent,hospital waiting onappeal decisionBrightGreen4 AppealDeniedOrange 5 AppealOverturnedBlue 6 Reviewed &OKTan 7 UnderpaymentRecord appeal anddenied, review forsecond level appealRecord appealed,denial overturnedRecord sent anddeemed billedcorrectlyRecord sent and determinedto be anunderpaymentFinancialImpactNo financialimpactTakeback hasoccurredTakeback hasoccurredTakeback hasoccurredTakeback hasoccurredTakebackoccurred/refund to bereceived orreceivedNo financialimpactAdditionalreimbursementto beor has beenreceivedIs your rehabilitation program readyto face the auditor’s microscope?Inpatient and outpatient rehab providers areexperiencing increased scrutiny from theirfiscal intermediaries and others. The 75%Rule, the Recovery Audit Contractor (RAC)project, and focused reviews for medicalnecessity have changed the way rehabilitationproviders operate.Most rehab providers have not establishedeffective mechanisms to assure the integrityof their operating and billing practices whenviewed by a third party. The full consequencesmay only be apparent when it is too late.Following the who, what, when, and how may not make the RAC processpainless. However, these helpful hints may save some time, avoidreinventing the process, and help you learn from those who have comebefore you. Having the right professionals at the table, open communication(both internally and externally), and an organized and thoroughtracking system is sure to ease the burden. nNoblis provides solutions-focused servicesacross the post-acute care continuum and wecan help solve the IRF compliance puzzle andhelp you face the future of rehab.Contact Noblis’ Center for Health InnovationPost-Acute Strategy experts (404.231.4422)to discuss customized solutions to yourcompliance needs. We will help you to climbout from under the auditor’s microscope.www.noblis.org/healthcare • 404.231.4422Health Care Compliance Association • 888-580-8373 • www.hcca-info.org29April 2008