You receive a RAC demand letter for repayment. But wait a minute before you pay up—you might want to take a close look to make sure your facility was really in the wrong. Karen Sagen, managed care leader at Bellin Health System in Green Bay, WI, who has worked in revenue cycle management for the past six years, has developed a step-by-step list of things to consider before pulling out your hospital’s checkbook.
The appeal process is much more complex than conducting a clinical review for an insurance company. Appeal writers must complete a full review of the record and consider multiple sources, such as CMS guidelines and managed care contracts, to successfully argue their case.