Description

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The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program

Amanda W. Berglund, MS, MBA; Elizabeth E. Lamkin, MHA

Learn how to respond to RAC audits. And more importantly, how to prevent them.

The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program is your answer to turning plans into proactive action for RAC success.

Authors Elizabeth E. Lamkin, MHA, and Amanda W. Berglund, MS, MBA, describe how to establish and sustain an effective RAC-preparedness structure that can be adapted to fit any organization's system. They provide best practices for successful processes and outline each staff member's role in your RAC audit program.

Whether you are responding to a Recovery Auditor or another government auditor, your program must operate as effectively as possible. You will use their tested, proven, and practical tools that will help you build a more effective billing compliance program. You'll learn how to bring finance, business office and clinical staff together for operational improvements that directly affect your bottom line.

The RAC Toolkit for Hospitals and Health Systems will help you get the job done right.

The RAC Toolkit for Hospitals and Health Systems will help you achieve the following goals:

• Take a systemic approach to RAC compliance
• Incorporate effective structure and processes to existing systems for measurable results
• Organize committees and facilitate information flow
• Appeal effectively and within deadlines
• Use proven tools and methods for an effective RAC program

Table of Contents:

• Chapter 1: RAC Program Overview
• Chapter 2: Preparing for RAC
• Chapter 3: The Right Structure: Organizing the Committees
• Chapter 4: The Right People: Three Critical Roles for RAC Prevention
• Chapter 5: Additional RAC Stakeholders
• Chapter 6: Automated Reviews
• Chapter 7: Complex Review and Extrapolation
• Chapter 8 The Appeal
• Appendix (Acronyms and additional resources)

Take advantage of these valuable tools included in your book:

• RAC appeal timeline
• RAC preparedness checklist
• RAC committee structure flowchart
• Organizational chart for RAC-related personnel
• Sample RAC committee meeting agenda
• Sample UR committee meeting agenda
• Complex case review worksheet
• Admission review continued stay and discharge review flowchart
• Patient status change letter template
• Automated review timeline
• Complex review timeline
• Appeal letter template for appeal level 1 redetermination
• CMS form 20027
• CMS form 20034
• CMS form DAB101

About the Author

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Elizabeth E. Lamkin, MHA, and Amanda W. Berglund, MS, MBA, are partners at Hilton Head, SC-based PACE Healthcare Consulting, LLC., which provides a broad range of strategic and tactical services for hospitals and healthcare providers.