Your Claims Editing Software Solution for Avoiding RAC Recoupments
The CMS RAC program has created a variety of cash flow, compliance and administrative burdens for healthcare providers. Payment recoupment exposure can result from claims submitted with error such as:
- DRG and coding errors
- Length of hospital stay
- Non-covered services
- Medical necessity
- Duplicate claims
ClaimsEditor® RAC Auditor examines the entire claim and identifies procedure to diagnosis mismatches, unbundling occurrences, nonspecific diagnosis codes, global service violations and other potential claim errors. This claims editing software solution allows providers to proactively mitigate their RAC audit risks and enhance other internal auditing activities.
The claims editing software solution acts as an RAC recoupment avoidance auditor so healthcare providers can be alerted to:
- Coding initiative violations
- Procedure/diagnosis relatedness
- Code validity
- Utilization errors
- Billing oversights
- Support documentation requirements
- Global period violations
- NCD, LCD, DME, Medical Necessity, and many more
Providers can also achieve true “clinical editing” specific to the clinical coding aspect of the claim including:
- Unbundling edits
- ICD/diagnosis/procedure code mismatches
- Global period violations
- Complete local coverage determination policies
- Correct coding initiatives (CCI)
Additionally, customers can collaborate with the Context team to customize rules based on prior RAC audit findings.
Contact us to request more information about our RAC auditor / claims editing software or watch an informative ClaimsEditor® RAC Solution demo video.
