RAC Consulting
Craneware InSight Consulting offers comprehensive Recovery Audit Contractor (RAC) audit services. We are prepared to manage some or all of the tasks related to Medicare RAC audits. We can appeal any type of denial through all levels of appeal. We worked with clients through the demonstration project and had a 93% successful appeal rate.
Record Verification and Scanning Service
Incomplete record submission was cited by RAC as the number one reason for denials, and also tops the list for CERT denials. Craneware InSight Consulting reviews records prior to submission for key missing record components that can lead to denials and scans and paginates each page of record. We prepare DVDs to RAC specifications and track due dates to assist client with meeting deadlines.
RAC Audit Appeals
Craneware InSight applies proven appeal strategies to your RAC denials, ensuring that revenue inappropriately targeted for recoupment by the RAC auditors is appealed and successfully overturned.
Medical Necessity Appeals
Craneware InSight Consulting has developed effective appeal arguments and strategies based on our experience of what worked at the ALJ level of appeal and above. The use of Hospital/UR Admission guidelines, physician orders for inpatient care, community standards of care, and the complexity of patient and/or procedure must be taken into account at the beginning of the appeal process to ensure success at the ALJ level.
Coding Appeals
For coding appeals, Craneware InSight Consulting verifies the validity of the denial and takes the follow up actions necessary to resolve the coding issue. These denials usually fall into three categories - coding errors, when the coded diagnosis/procedure was not documented by the physician in record, or simply missing documentation.
Payment Reconciliation
Fully assess your organization’s process for assuring claims are paid correctly and fully. This includes a review of the identification, feedback and resolution of under and over payment variances, either with or without the use of a contract management system. Procedures will be developed to assure all revenue associated with underpayments is collected in full. Revenue identified as “lost” will be recovered within payor allowable time limits.
Experienced Staff
Craneware InSight Consulting employs certified case managers, certified inpatient and outpatient coders, experienced patient financial service and HIM management staff for billing error denials, on-call physician advisors, and affiliated legal counsel.
