Carol Spencer

In a recent educational memo (SE1121), the Centers for Medicare & Medicaid Services (CMS) advised hospitals, once again, to improve their Medicare documentation in order to avoid unnecessary claims' denials by the Recovery Audit Contractors.

The American Hospital Association (AHA) continues to collect and report valuable data from its web-based RACTrac survey.

As providers keep hearing over and over-from RACs and their own Medicare contractors, insufficient documentation is frequently the reason for claim denials.

There are many steps that inpatient hospital providers can take to avoid denial of their claims when submitting Medicare fee-for- service claims.

Inpatient acute care hospital billing staff need to make sure medical documentation submitted demonstrates evidence of the clinical need for patients to be admitted and that it fully and accurately identifies any subsequent care provided during that stay.

In order to remain in compliance with Medicare rules, and avoid denials by recovery audit contractors (RACs) and others, hospitals must reduce outpatient procedures performed during inpatient stays.

Many hospitals are receiving recovery audit contractor (RAC) denials based on physicians' documentation of major complications and/or co-morbidities (MCCs) and complications and/or co-morbidities (CCs).

Do you know how to review your Medicare remittance advice, or RA, for Recovery Audit Contractor (RAC) activity and accurate financial data?

With the permanent Recovery Audit Contractors (RACs) in motion, hospital teams are gearing up by formulating project plans to minimize financial exposure.