The Recovery Audit Contractor (RAC) initiative has been, and will continue to be, burdensome and costly for hospitals to log record requests, copy and mail the medical record to the RAC, track RAC responses and FI remittance advice, perform secondary review of the record and the denial, as well as investigate and defend the hospitals' position. This process has been so costly and resource intensive that many hospitals have not fully investigated and challenged the RAC when the denial is inappropriate.
Denial Management Services (DMS) from the Florida Hospital Association Management Corporation are designed to manage the RAC process for the hospital. Our denial management team consists of experienced physicians, Certified Utilization Review/Case Management Professionals, and HIM professionals with denial defense experience in the areas of medical necessity and DRG/coding assignment. The DMS team will efficiently and effectively defend and manage the appeal process from the beginning to final determination.
For more information, contact Jennifer Greenhalgh.