Tips from our featured course
Case Management as a Revenue Protector -
The Benefits of an Effective UM/UR Team
Whether the patient has Medicare, Medicaid, commercial insurance or is uninsured, effective UM will ensure that across the continuum of inpatient and outpatient care, the healthcare entity will be reimbursed the maximum amount eligible for the patient's care.
Ineffective UM results in reduced or denied payments due to incomplete, inappropriate or ineffective clinical documentation justifying the delivery of care.
Effective UM processes ensure appropriate reimbursement (financial resources) and support the efficient expenditure of these resources.
[UM, Module A, Dynamics and Structure]
Oversight and RAC Activity
The Tax Relief and Health Care Act (TRHCA) of 2006 made permanent the Medicare Recovery Audit Contractor (RAC) program to identify improper Medicare payments in all 50 states. This includes both:
As required by The Tax Relief and Health Care Act of 2006, the RAC program was implemented in all 50 states.
RACs cite inpatient coding error as the most common reason for complex claim denials.
[UM, Module B, External Forces]