A Subsidiary of Healthcare Provider Services

RAC Pre-Audit & Appeals Services

By 2010, CMS will have expanded the Recovery Audit Contractor (RAC) audits nationally. The audits will cover a look back period of three years and up to the date of the claim submission. HMI Corporation is offering the following services to hospitals to help identify and reduce potential risk and to address RAC notification of improper payments. The Revenue Recovery Contractor Pre-audit and the Revenue Recovery Contractor Reviews and Appeals services encompass specific approaches to assisting hospitals in managing their internal RAC processes. Our services also identify opportunities to make process improvements and further educate the staff in the health information management, business office, and compliance/audit departments.

RAC Reviews and Appeals:  This service provides hospitals assistance in reviewing the results of the RAC’s audit to determine if the hospital should actively pursue a rebuttal in the event the RAC has issued an improper payment letter. The service includes:

  • Review of the RAC’s audit report and supporting Medicare coding and billing criteria cited,
  • Review of the patient medical record and corresponding billing document, and
  • Assist in preparing the rebuttal statement that will be used by the hospital to appeal the overpayment identified.

RAC Pre-audit Reviews: This service assists hospitals in reviewing billed inpatient and/or outpatient services to identify potential risk and improve processes to reduce future occurrences. The service includes:

  • Review of the patient medical records and corresponding billing documents to assess documentation,
  • Validation of coding and billing, and
  • Verification of medically necessary services. 

With both services, HMI also provides the designated staff with an overview of the findings and recommendations for improvements and provide coding and billing guidance to support the recommended changes.

To learn more about these services or request information, please contact (800) 659-5145 to speak with a corporate development representative.

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