Preparing for the RACs

Identify Risk Areas
Implement DRG audits
Assign a nurse auditor to review medical necessity & high-risk areas
Billing Compliance
Pharmacy/Ancillary Charges in Chargemaster

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    Healthcare Coding and Documentation 2009 Update

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    Presented by
    Amper’s Healthcare Services Group

    Preparing for the RACs
    • Identify Risk Areas
      • Inpatient
        • Surgical Procedures in Wrong Setting
        • Excisional Debridement
        • IRF Services Following Joint Replacement Surgery
        • Cardiac Defibrillator Implant in Wrong Setting
        • Treatment for Heart Failure & Shock in Wrong Setting
        • Respiratory System Diagnoses with Ventilator Support
        • Extensive OR Procedures Unrelated to Principal Dx
        • DRG Changes Due to Wrong Dx Code or Principal Assignment
        • DRG Changes Due to Wrong Procedure Code(s)
      • Outpatient
        • Speech-Language Pathology Services
        • Infusion Services
        • Colonoscopies
      • Physician
        • Pharmaceutical Injectables
        • Vestibular Function Testing
        • Duplicate Claims
    • Implement DRG audits
      • Monitor upcoding/downcoding
    • Assign a nurse auditor to review medical necessity & other identified high-risk areas
    • Billing Compliance
      • Review bill error/correction reports
      • Review incorrect units billed
    • Pharmacy/Ancillary Charges in Chargemaster
      • Verify units of service
      • Verify correct dosages

    The material contained in this presentation is for general information and should not be acted upon without prior professional consultation.


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