RAC question

kshumpertkshumpert
in CDI Talk Archive
I know that many of you are not as heavily involved with RACs as a CDI, however I am reaching out with a question. I want to know if your facility uses an outside vendor for second level appeals. If so, who do you use? Would you kindly check with your RAC coordinator? Thanks so much!

Comments

  • dbutlerdbutler
    edited May 2016
    Our facility uses EHR. I know they are popular with a lot of facilities.

    Melissa -- this might be a good poll question, once there are enough answers to the poster's question to be able to develop a on-line poll response list.

    Don
  • katysuegood@gmail.comkatysuegood@gmail.com
    We just implemented EHR. I dont have direct involvement in it but I do go to our monthly RAC meetings and I am in the same office as UR nurses so I have a rough understanding of the process.

    Katy
  • kmckaigkmckaig
    edited May 2016
    We use EHR for appeals. We love them and have had good success. We shopped around at one point but no one offered comparable expertise.
  • dbutlerdbutler
    edited May 2016
    Agreed, my second hand impression is that they are the current leader. There certainly is enough (and growing) business with all of the government and private initiatives either in place or starting. I would suspect that there might be a couple of others less visible but also quite strong.

    They seem to be managing their growth -- difficult to recruit and train with rapid growth to be able to maintain the level of expertise.
    Don
  • debbie.taylordebbie.taylor
    edited May 2016
    We handle our own 1st and 2nd level appeals internally. For our ALJ level appeals we use Wachler & Associates, P.C.
    210 E. Third Street
    Suite 204
    Royal Oak, MI 48067
    248.544.0888 (tele)
    248.544.3111 (fax)
    Have had 1 ALJ Hearing and the overpayment was overturned. The second ALJ Hearing the position paper was sent by Wachler and the overpayment was overturned without a hearing.
  • Unknown
    edited May 2016
    EHR

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com
  • afulmerafulmer
    edited May 2016
    Our facility does not use an outside vendor for appeals. That is with one
    exception, when the record was referred (prior to discharge) and approved by
    EHR (our contracted physician advisor company) as an appropriate inpatient
    status, in that case they, EHR, handles the final appeal.
  • afulmerafulmer
    edited May 2016
    Don,

    It is my understanding the EHR does not intervene until the denial reaches
    the final appeal level. I know that is true with those that EHR approved as
    Inpatient Status (original Observation status) while patient was actively a
    patient.

    Joan
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