Applied Management Systems (AMS) utilizes a multi-phase approach to assist hospitals with RAC Audit Preparation, Management and Appeals
Preparation –
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As many over-payments are attributed to incorrect coding and unnecessary medical procedures, AMS begins with RAC audit preparation: assessment of documentation and coding, followed by an evaluation of medical necessity from the medical record. This phase identifies the risks and weaknesses in the system, and prepares the department for the RAC appeal process. A root cause analysis is also performed to complete the phase, and detect any large-scale documentation and/or coding issues.
- Management –
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The volume of RAC Audits is about to explode in numbers that will be difficult for providers to manage. The RAC process moves very quickly upon arrival at a hospital and request for medical records. Providers lose their power of rebuttal if they provide no response within a given time frame. This makes the tracking of RAC deadlines and correspondence a critical piece of the process. AMS will oversee the management and course of RAC audits, and ensure that the hospital meets all timeframes in order to respond and appeal to overpayment claims.
- Appeal –
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AMS consultants are highly skilled in coding and RAC appeals. We will review and analyze your denials to identify appeal opportunities for DRG, medical necessity and automated claims. We use a denial tracking and management database to manage appeal deadlines, response dates, evidence, appeal rationale and alerts.
Benefits of Appeal:
- More Appeals means less exposure
- Achieve optimal financial performance