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Recovery Audit Contractor

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1. Recovery Audit Contractor

Recovery Audit Contractor Recovery Audit Contractor Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Recovery Audit Contractor Recovery (...) Audit Contractor Aka: Recovery Audit Contractor , RAC II. Definition: Recovery Audit Contractor (RAC) Private auditors contracted by government to recover "over-billing" dollars Auditors receive incentives for recovery and awarded higher bounty for greater recovery Review is often based on software mining and assign error rates based on certain number of charts (e.g. 100) Error rate is then extrapolated over prior years and revenue loss for facilities can be substantial based on small reviews III

2018 FP Notebook

2. Recovery audit contractor audits and appeals at three academic medical centers. (PubMed)

Recovery audit contractor audits and appeals at three academic medical centers. Outpatient (observation) and inpatient status determinations for hospitalized Medicare beneficiaries have generated increasing concern for hospitals and patients. Recovery Audit Contractor (RAC) activity alleging improper status, however, has received little attention, and there are conflicting federal and hospital reports of RAC activity and hospital appeals success.To detail complex Medicare Part A RAC (...) activity.Retrospective descriptive study of complex Medicare Part A audits at 3 academic hospitals from 2010 to 2013.Complex Part A audits, outcome of audits, and hospital workforce required to manage this process.Of 101,862 inpatient Medicare encounters, RACs audited 8110 (8.0%) encounters, alleged overpayment in 31.3% (2536/8110), and hospitals disputed 91.0% (2309/2536). There was a nearly 3-fold increase in RAC overpayment determinations in 2 years, although the hospitals contested and won a larger percent

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2015 Journal of Hospital Medicine

3. Recovery Audit Contractor

Recovery Audit Contractor Recovery Audit Contractor Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Recovery Audit Contractor Recovery (...) Audit Contractor Aka: Recovery Audit Contractor , RAC II. Definition: Recovery Audit Contractor (RAC) Private auditors contracted by government to recover "over-billing" dollars Auditors receive incentives for recovery and awarded higher bounty for greater recovery Review is often based on software mining and assign error rates based on certain number of charts (e.g. 100) Error rate is then extrapolated over prior years and revenue loss for facilities can be substantial based on small reviews III

2015 FP Notebook

4. Recovery audits: Practical update for neurology practices (PubMed)

Recovery audits: Practical update for neurology practices Recovery Audit Contractors (RACs) are contracted by the federal government to review providers' medical billing. Experience has demonstrated substantial savings to the strapped Medicare fund, fueling increased scrutiny. RAC audits are constrained to published focus areas, and its targeted approach makes use of sophisticated analytics. Although some of the analyses used by the RACs may be proprietary, much of the auditing process (...) is transparent, allowing providers to prepare their practices in advance of audits. This article reviews the current state of RAC auditing and offers strategies to minimize financial pain and leverage the process for competitive advantage.

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2013 Neurology: Clinical Practice

5. RAC Attack-Medicare Recovery Audit Contractors: What Geriatricians Need to Know. (PubMed)

RAC Attack-Medicare Recovery Audit Contractors: What Geriatricians Need to Know. Knowledge of Medicare policies and procedures is integral to the practice of geriatric medicine. Within the past several years, there has been a focus on Medicare fraud, abuse, and waste in healthcare spending. One program, Medicare Recovery Audit Contractors (RAC), has recently been launched to identify improper payments by performing postpayment reviews of Medicare Part A and Part B claims. During the program (...) pilot project in only three states, more than $1 billion in incorrect payments were identified, with the overwhelming majority being overpayments that had to be returned to the Medicare Trust Fund. In 2006, Congress mandated that the RAC program be rolled out nationwide, which is ongoing. The audit focuses on documentation of medical necessity for inpatient admission and the 3-day qualifying stay for skilled nursing care, important concerns for geriatricians. This article describes the RAC program

2010 Journal of the American Geriatrics Society

6. Community pharmacies: promoting health and wellbeing

continuing treatment. Consider designing triage activities to reduce multiple assessments and waiting times after people are referred. For example, after identifying harmful or dependent alcohol consumption, consider providing access to alcohol services that does not require reassessment and a return to the start of the treatment pathway. (Harmful and dependent alcohol consumption could be identified using the AUDIT tool or another threshold used locally.) 1.6.2 Consider referring people to other (...) #notice-of-rights). Page 10 of 28drug misuse recovery support weight reduction services local authority, NHS or community and voluntary sector organisations for: weight loss programmes or support groups mental health and wellbeing support specialist treatment and recovery support for drug misuse and dependence support for carers adult and children's social care. 1.6.3 When making a formal referral to another service, explain to the person why they are being referred, where they are being referred

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

7. Handbook on designing and implementing an immunisation information system

of standardised terminology that is used throughout health information systems, and ideally increases quality of data captured due to the consistent recording of immunisation and demographic information. IIS should be designed to allow for the audit of data quality in terms of completeness, reliability, accuracy, and timeliness. To support the benefit/ risk monitoring of vaccines and vaccination programmes The need for immediate and high-quality data is an essential part of any immunisation programme

2019 European Centre for Disease Prevention and Control - Technical Guidance

8. Individualised funding interventions to improve health and social care outcomes for people with a disability

*)):ab,ti) OR 'cash for care':ab,ti OR 'consumer directed care':ab,ti OR 'direct payment':ab,ti OR 'indicative allocation':ab,ti OR 'individual budget':ab,ti OR 'individual service fund':ab,ti OR 'managed account':ab,ti OR 'managed budget':ab,ti OR 'notional budget':ab,ti OR 'personal budget':ab,ti OR 'personal health budget':ab,ti OR personalisation:ab,ti OR 'personalised care':ab,ti OR personalization:ab,ti OR 'person centred':ab,ti OR 'pooled budget':ab,ti OR 'recovery budget':ab,ti OR 'resource

2019 Campbell Collaboration

10. Concise practice guidance on the prevention and management of accidental awareness during general anaesthesia

of Anaesthetists of Great Britain & Ireland and its related charity, AAGBI Foundation (England & Wales no. 293575 and in Scotland no. SC040697). 3 Association of Anaesthetists Association of Anaesthetists 3 Summary The 5th National Audit Project (or NAP5) of the Royal College of Anaesthetists and Association of Anaesthetists was the largest ever study into accidental awareness during general anaesthesia (AAGA). Numerous publications emerged from the project and whereas a comprehensive list of 64 (...) recommendations were made, the full report and associated publications were primarily academic outputs not accessible to all practitioners as a day-to-day ready reference, nor did they provide practical recommendations that individuals could use in their daily practice. The purpose of this publication is to distil and interpret the findings of the 5th National Audit Project into actions that individuals (and organisations) can follow to reduce the risk of accidental awareness. Key Recommendations 1. All

2019 Association of Anaesthetists of GB and Ireland

11. HTA of C-reactive protein point-of-care testing to guide antibiotic prescribing

to procure the devices in order to ensure the systematic adoption and use of CRP POCT technology by GP contractors in primary care. The use of non-financial incentives should also be considered to promote adoption and ongoing use of the technology. Health Technology Assessment (HTA) of CRP POCT Health Information and Quality Authority viii ? Consideration may be given to introducing clinical guidelines to support the use of CRP POCT to inform antibiotic prescribing decisions for acute RTIs

2019 Health Information and Quality Authority

13. Use of patient-reported outcome and experience measures in patient care and policy

of information that should help providers to identify the reasons for their performance, and then to identify what they need to do in order to improve .[4] ‘Audit and feedback’ about PROMs and PREMs are believed to reveal flaws in care processes and competencies of healthcare professionals. These performance data are not necessarily released to the public. [30] PROMs and PREMs cannot be used in isolation since ‘audit and feedback’ only seems to work when it identifies specific individuals or groups

2018 Belgian Health Care Knowledge Centre

14. Management of Pregnancy

these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 3.0 – 2018VA/DoD Clinical Practice Guideline for the Management of Pregnancy March 2018 Page 2 of 147 Prepared by: The Management of Pregnancy Work Group With support from: The Office of Quality, Safety and Value, VA, Washington, DC & Office of Evidence Based Practice, U.S. Army (...) may be planned for breech presentation, prior uterine surgery, or as a response to unexpected maternal or fetal complications such as abnormal labor or a concerning fetal heart rate.[ ] Cesarean delivery is a major surgery with associated risks (e.g., risk of infection, hemorrhage). Cesarean delivery requires a longer period for maternal recovery than vaginal birth and has also been associated with neonatal complications, primarily respiratory.[ ] There has been a downward trend in cesarean births

2018 VA/DoD Clinical Practice Guidelines

16. Cataracts in adults: management.

: What it involves and how long it takes Possible risks and benefits What support might be needed after surgery Likely recovery time Likely long-term outcomes, including the possibility that people might need spectacles for some tasks How vision and quality of life may be affected without surgery. Before Cataract Surgery At the preoperative outpatient appointment, review and expand on the topics in the previous recommendation, and give people information about: The refractive implications (...) this initial point. Non-comparative Studies Throughout the guideline, wherever possible, data were always presented from comparative studies, with non-comparative studies only considered when this was the only data available. All non-comparative study designs (case series, audit data, surveys, etc.) were analysed under the same framework, regardless of the underlying question they sought to address. Modified GRADE for Non-comparative Evidence GRADE has not been developed for use with non-comparative

2017 National Guideline Clearinghouse (partial archive)

17. BTS guideline for oxygen use in adults in healthcare and emergency settings.

after stroke should be nursed in the recovery position with the paralysed side lowest. Good Practice Points Regarding Patients with Suspected Hyperventilation : Organic illness must be excluded before making a diagnosis of hyperventilation. Patients with a definite diagnosis of hyperventilation should have their oxygen saturation monitored. Those with normal or high SpO 2 do not require oxygen therapy. Rebreathing from a paper bag can be dangerous and is NOT advised as a treatment (...) saturation via pulse oximetry prior to and during the procedure, and in the recovery period, particularly fibre optic bronchoscopy and upper gastrointestinal (GI) endoscopy where a reduction in arterial oxygen saturation (SaO 2 ) is common, particularly with concurrent use of sedation ( grade C ). Significant arterial oxygen desaturation (SpO 2 <90% or fall of 4% or more that is prolonged [>1 min during endoscopy procedures]) should be corrected by supplemental oxygen with the aim of achieving target

2017 National Guideline Clearinghouse (partial archive)

18. Eating disorders: recognition and treatment.

and duration of psychological treatments on relevant manuals that focus on eating disorders. Professionals who provide treatments for eating disorders should: Receive appropriate clinical supervision Use standardised outcome measures, for example the Eating Disorder Examination Questionnaire (EDE-Q) Monitor their competence (for example by using recordings of sessions, and external audit and scrutiny) Monitor treatment adherence in people who use their service Coordination of Care for People with an Eating (...) monitoring of weight, mental and physical health, and any risk factors Be multidisciplinary and coordinated between services Involve the person's family members or carers (as appropriate) When treating anorexia nervosa, be aware that: Helping people to reach a healthy body weight or BMI for their age is a key goal and Weight gain is key in supporting other psychological, physical and quality of life changes that are needed for improvement or recovery When weighing people with anorexia nervosa, consider

2017 National Guideline Clearinghouse (partial archive)

20. Management of Posttraumatic Stress Disorder and Acute Stress Reaction

testing and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 3.0 – 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder June 2017 Page 2 of 200 Prepared by: The Management of Posttraumatic Stress Disorder Work Group

2017 VA/DoD Clinical Practice Guidelines

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