As the threat of a visit from recovery audit contractors (RAC's) looms over healthcare providers, there are several coding problems that hospitals should address before the auditors arrive, according to Becker's Hospital Review.
Complex rules about the differences between one-day stays and inpatient stays make billing practices an easy target for auditors. Incorrectly billing a patient as full admission could leave the hospital bill at risk of recoupment, so it is important to have a proper screening program set up at admission.
"Getting the patients' bed status right from the start will save a lot of money," Elizabeth Lamkin, CEO of Pace Healthcare Consulting in Hilton Head, South Carolina, told the news source.
Complicated documentation, coding and modifier rules make outpatient hospital infusion therapy another area that is susceptible to inaccuracies. Common mistakes include billing the same code multiple times, not billing in six-milligram units and inaccurately recording start and stop times.
Recording an incorrect discharge status – for example, entering the code for sending a patient home when he or she is actually sent to a rehabilitation center or nursing facility – leaves a hospital at risk of RAC take-backs of diagnosis-related groups.
Other common targets for RAC's include diagnosis codes and coding for excisional and non-excisional debridement, according to RAC Monitor.