Recovery Audit Contractor Services (RAC)
QHR brings national hospital operational experience to its consulting engagements.
From our work with clients in the RAC Demonstration Project states, we can help your hospital prepare for RAC, so that risks are minimized and revenue integrity maintained.
Here’s how QHR can help.
Preventing RAC Denials
Less than 5% of RAC denials are overturned on appeal. QHR moves hospitals beyond identifying and appealing denials to avoiding RAC denials altogether. We deliver practical process improvement recommendations and implementation assistance that minimizes future errors.
Auditing
- Pre-RAC audits
- Independent validation of RAC audits
- Monthly or quarterly reviews
Coding Services
- DRG Validation
- “Present on Admission”
- MS-DRG
- Physician Queries
- Compliance Design
Education
- Senior leadership training
- Team training
- Case Management Education
- Physician Development
RAC Preparedness Analytical Review
- Quality Improvement Process
- Implementation
- Core Measures Improvement Plan
- Hospital Administration Overview
- Quality of Care Review
Appealing RAC Denials
Sometimes, RAC denials are unavoidable, and we can provide you with an effective process and guidance when necessary to win RAC appeals.
- Assistance establishing a process and a comprehensive hospital team for RAC appeals
- Denial Recovery
- Clinical Appeals
- Administrative Appeals
Getting Started
QHR does not work for regulators or payers to reduce a provider’s payment. Our healthcare professionals can work side-by-side with your staff to:
- Test the hospital’s state of readiness
- Identify the root causes of vulnerability
- Develop and implement process improvement plans that correct vulnerabilities
- Rapidly develop, implement and staff your RAC department infrastructure
- Build/enhance skill sets of staff through focused education
- Refocus adjustment and rebilling activities
- Validate/retest the hospital’s state of readiness
Peace of Mind
QHR offers monthly and/or quarterly reviews to ensure ongoing compliance with CMS regulations and risk mitigation. Our audit process and data handling procedures obey the Health Insurance Portability and Accountability.
