Medicare reimbursements for a hospital and its physicians are unaligned, reports RAC Monitor. Because hospitals are reimbursed by Medicare Part A and doctors by Medicare Part B, physicians don't have a direct financial incentive to help hospitals with RAC audits. Without proper alignment, doctors can be reimbursed for a RAC claim while the hospital might not.
"The challenge hospitals face with the RAC audit as it relates to insufficient medical documentation is getting physicians to document clinical treatment given to patients accurately in order for the hospital to be reimbursed properly by Medicare," notes RAC Monitor columnist Leo Paul D'Orazio, managing director of healthcare for WithumSmith+Brown.
To minimize the risk of RAC take-backs, hospitals must educate their on-staff physicians. RAC Monitor suggests holding physician education meetings that explain how insufficient documentation or improper coding can hurt the hospital's bottom line.
Hospitals also should make it as easy as possible for a physician to review RAC demand letter claims. A "physician friendly" process will ensure that the physician provides the right supporting documentation so the hospital can get paid, notes RAC Monitor.
- read the RAC Monitor article