Question

1. Determine what types of audits the RACs perform? What type of audit denial would a Health Information Management professional be involved in?
   
   
   
2. Evaluate the top reason for denials and what do you believe are ways to prevent denials in the future?
   
   3. identify how many days a healthcare provider has to submit medical records requested by a RAC?

4 List all the level of appeals a healthcare provider has to try and overturn the denial determination.

Answer 1

Image 1 : explain types of audit RAC perform and types of audit denial health information management professional be involved in.

Image 2: explain top reasons for denials and ways to prevent denials in future

Image 3: explain identify how many days a healthcare providers has to submit medical records requested by RAC

Image 4 : describe all levels of appeals a health care provider has to try and overturn the denial determination.

is Types of Audits RAC Perform : RAC conduct two types of Audits. Complex Toda Automated RAC Audit RAC Audit. " It relies on an analysis of claims data to make a determination > It requires moue-in-depth analipis and always involves a request for medical Mecords. > These may involve questions of medical necessily, puoper documentation and others wherre judgement is required. • Automated reviews que Based on cleau policies in Law, wegulations and guidance. * Health Information Management professional be involved in complex RAC audits because it mequites in-depth analysis and always involves por medical records. They Mequire proper documentation medical necessity. So, that a clear the Mecords can be collected. questions of oumation about

2nd

* TOP Reasons fose Denials and ways to prevent Denials. ☺ * Top Measons for denial aue as Pollows S- ay The claim was submitted to the wrong contractou. by Patient ID is not valid c) Patient Name, Date of Birth does not match the Medicare record. d) procedwie code for date of service is invalid. es Refeving physician's NPI is invalid. * Ways to prevent Denials in Future :- - There are some ways Helps in prevention of Denials in future : > Educate 6 communicate > Veuity inswance prior to service > know your payers > Document accurately > Leverage technology Ata s . Learn from mistakes.sho p

3rd

* Days required to submit medical Records - * Health care provider Has to submit medical elecogede to RAC auditors under complex reviews upto to 45 days. utsentiros anos a ot r ontenantahan * Providers get 120 days to file an appeal for Re-determination of the Review.

4th

Levels of Appeals :- There are essentially power Levels to the provideus appeal are explained as Below - b o la 1) Redetermination To Medicare Contractose >> Reconsideration to a Qualified mdependent rol sist to attrators Contractor. 3) Hearing Befoue an Administrative Law Judge 41 Review By Medicare