RAC Audit

Support

 [Recovery Audit Contractors - RACs]

MARSI has been actively involved since the inception of the RAC Demonstration Project.

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.

MARSI's coding and physician experts provide a strong appeals process and individualized letters of appeal.

A decade ago, we began a focus on Observation vs. Inpatient admission status.  There seemed to be great confusion and a high number of medically unnecessary inpatient admissions.  It looked like trouble ahead for our clients and we aimed at fixing it.  The RAC focus was no surprise.

We are very successful.

Why?  Partly because most of the RACs frequently stray from coding and medical necessity guidelines.  They also make denials based on strict InterQual or Milliman criteria, which does not encompass all admit status issues.  

MARSI's RAC services include

• Observation vs. Inpatient Status
• Continue Length of Stay
• Denials Management
• RAC Appeals
• Physician Advisor Support Services
• Physician/Clinical Documentation Improvement
• Physician and Staff Education
• DRG Audits and Queries
• Hospital Owned Practice Audits and Appeals