Our proven approach includes proactive and retroactive components. We address the RAC focus areas to diminish the risk of future adverse determinations.
Proactively, we target the same DRGs that the RACs target. MARSI provides strong physician advisor support for Inpatient vs. Observation, Continued Stay and upcoming medical necessity RAC audits.
We assist the hospital in responding to denials on all levels of appeal.
Just recently, the RACS have been given the “green light” to review and deny for inappropriate coding and admissions based on medical necessity. This is monumental. CMS, previously, has stayed away from questioning physician’s evaluations and determinations. Medical necessity does just that.
We have been preparing for medical necessity reviews for years. They will require another level of initial screening and, to be successful, physician review. We have tested our process, and it works.