RE: cdi_talk digest: June 07, 2011
Glenn, we have a Revenue Integrity Specialist who's only job is to handle RAC and other denials. I think she is using a software to do that, but I'm unsure what it is. Perhaps RAC TRAC, but I'm not sure if that is it or if she also has another. Do you want me to find out? We have a committee (QBC-Quality/Compliance/Billing) that meets monthly to bi-monthly to discuss these issues and to strategize how to handle them. For the most part, we are appealing denials and winning most. We have less of an issue with denials from the RAC than we do from the Humana folks, but we often win those on appeal. A few have gone to ALJ and we've won all of those.