Educate

The second and probably most important component of the P-E-M strategy for dealing with the RACs has to do with education in two primary areas:  1) learning everything you need to know about the RACs; and 2) making certain clinical staff have the training they need to approporately and accurately assess and document patient eligibility.  In hospice, patient eligibility equates to medical necessity and when the RACs begin their complex reviews, that is what they will be targeting.  Hospice clinicians must be able to assess patient eligibility for hospice care as well as eligibility for higher levels of care such as the general inpatient level of care and continuous care.  Ensuring your hospice can "make the case" for the eligibility of each patient for whom you submit claims is the single most effective defense against RAC recoupments.

Monitor the "Educate" category in the sidebar for resources related to learning about the RACs and improving clinician documentation.