Regulatory Audits Desk Reference 2012

Regulatory auditors (RACs, MACs, MICs) are pursuing hospitals nationwide for overpayments that may have occurred in the prior three years. Hospitals need a strategy and a process for addressing these audits and repayment demands. Approximately 67 percent of RAC appeals are successful, but only 12 percent of repayment demands are appealed.

Successfully respond to regulatory auditor's automated and complex claim reviews with this new reference from Ingenix. You'll get expert coding and documentation guidance and learn documentation requirements for targeted inpatient medical necessity reviews. Ensure successful appeals for overpayment determinations with these features:

Key Features and Benefits:

• Understand audit threats. Complete listing and description of all the regulatory agencies and their auditing functions
• Appeal letter templates. Includes customizable response letters for overpayment demands with recommended language.
• List of laboratory and diagnostic tests commonly associated with MCC and CC diagnoses.
• Documentation requirements. Find out what documentation is needed for each targeted DRG and for targeted inpatient medical necessity reviews.
• Best practices. Get expert insight on responding to automated reviews.
• Stay up-to-date. Updated content delivered on our exclusive, customers-only webpage.

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