QuestionQuestion

You are the Compliance Officer of an acute care hospital that has been receiving billing denials from the Recovery Audit Contractor (RAC) at a rate of almost 60%, which is significantly higher than the national rate of 40%.

As the Compliance Officer, write a paper on the most likely causes of this high denial rate and how you will address these issues, e.g., new policies, new processes, an oversight committee, etc. and present to the class.

At the end of the paper you should list your sources but this is not included in the length of the paper.

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Recovery Audit Contractor (RAC)
According to the Office of Inspector General Report Card of 2010 (Hanson, 2015) the accuracy of physician billing of evaluation and management services had significant issues. Released in 2014 the reported indicated the accuracy of the claims was 42% due to incorrect codes with 19% of the claims were lacking documentation.   It is worth noting there no improprieties related to improper payments for surgery or testing. It was estimated in 2014 Medicare would lose 12.7% of fee-for-service payments or $46 billion in payments, writes Hirsch (2015).
Conducting audits of medical records is not a mandatory procedure with many practices opting not to undertake this process for a number of reasons. Undergoing an audit of a practice’s medical records is a process not known by every practice. The amount of preparation in terms of time and work hours is a hurdle many practices do not want to come up against the challenges necessary. Understanding the fundamental aspects of the audit process is not as complicated as it may seem providing the process is continuous throughout the year.
As the error rate continues to escalate the number of practices approaching agencies tasked by the government to perform audits grows. The Comprehensive Error...

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