The RAC Survival Guide: Successful Management of Recovery Audit Contractors

Softbound Book + Bonus CD-ROM
ISBN 1601462824
978-1-60146-282-4
HCPro
November 2009
(click button below for the very best currently available price for this guidebook)

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:
- Redetermination
- Reconsideration
- 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

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.

With more than 20 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its clients assistance and expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.

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