So here we are, at a facility of about 500 beds, in a room with the CEO, the CFO, the Corporate Compliance Officer for the parent firm, some outside auditors, at least one lawyer, four key MDs for the facility, and the VP of Medical Affairs, all gathered to discuss the RACs — the impending attack of the RACs. Yes, our favorite subject, go figure. We give our now fairly memorized presentation about the RACs, how they began, what they did, what they are doing now, and what they’ll be doing in the near future. Probably at their doorstep, too.
What the MDs were especially astonished to find out is that THEIR incomes are going to affected, as well as the hospital’s. Not only were they unaware of how the RACs operated, but they were also unaware of how the RAC could reach into their pockets, THRU the hospital claims.
Here’s what we mean:
When a RAC disallows and takes back reimbursement for a hospital claim, any attendant professional services (i.e., the MD’s billings) can ALSO be disallowed, and taken back, especially if the claim was disallowed due to lack of documentation to support Medical Necessity.
After we finished the presentation, the VP of Medical Affairs, an MD, asked if we knew how many MDs in the country are even aware of the risk that the RACs pose to their livelihood. Our answer: we don’t have a number, but we are certain it is very small, ridiculously so. Less than ten percent? Yes, we think that is probably about right.
One of the MDs then said, “Wait a minute… so what you’re telling us is that for the first time, it is in the interest of the physician to work directly with the hospital to insure that they get reimbursed correctly?”
Yes, that’s EXACTLY what we are saying. Both MDs and hospitals need to pay attention. This is not just about coding! The hospital is dependant upon the coder to properly code a claim. The coder is totally dependant upon the MD for the documentation for that claim.
Physicians must learn at least some of the Case Management Protocols, which are now more than ever being required to ensure proper, optimized reimbursement. (Or in some cases, any reimbursement AT ALL.)
We’ll be discussing this more, in further posts. You might also wish to read some of our previous posts, such as these:
What’s Medical Necessity? Try…40%
If you’re new here, you may not be aware that we are still completing a series of Live eLearning eVents (webinars) based on RACs. We’ve completed eleven, to date, and have ten more in the queue.
Click HERE to see a list of all courses available, online. Click HERE to download a catalog of courses.
Click HERE to see a FREE PREVIEW of our course at www.myedutrax.com about Documentation & Coding Hot Spots in the current RAC environment.
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