"We have begun to see significant numbers of reversals of clinical diagnoses made by treating physicians," writes Paul Weygandt, MD, JD, MPH, MBA, CPE, in his forthcoming article in Thursday's edition. Reports Weygandt, "while part of the overall review process, these recent interventions warrant special attention."
In "DRG Validation - Plowing New Ground: Intrusions into the Practice of Medicine," Weygandt discusses how RACs, MACs and QIOs now are engaged in DRG Validation process and what it means to physicians.
You've Got Mail
After you've captured the attention of your physicians, you can go on to explain what you'll be up against when RAC letter requests start arriving - unless they already have. Carol Spencer, RHIA, CCS, CHDA, and a senior healthcare consultant with Medical Learning Inc., highlights key similarities and differences in her article, "Understanding the RAC Letter Requests."
Arcane But Real
Just when you think you have your mind almost wrapped around the RACs, someone like RACmonitorEnews contributing editor Carla Engle, MBA, brings an arcane issue to the surface. In her article, "Reconciling Your Remittances: Remark Code N432 Tracks RAC Impact on Cash Flow," Engle, a product manager at MediRegs, discusses some of the problems related to this code that have been happening for providers nationwide. What's the outlook?
Look for system corrections in April and July 2010, she reports, but there's more. Film at 11.
With this week's 14th annual HCCA Compliance Institute underway, Bret Bissey, FACHE, MBA, CHC, and director, Regulatory Consulting for IMA Consulting, discusses the fact that RACs are being instructed to refer cases of fraud to the OIG. In his article this Thursday, "RACs Being Educated on Referring Cases for Fraud Review. Implications for Providers: Office of Inspector General and False Claims Act," Bissey cautions providers that "a referral of a claim for fraud investigation to OIG or the U.S. Attorney's office continues to be a real financial threat that must be taken seriously by all healthcare providers."
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