We are well aware of the current challenges that the long-term care industry is facing and are doing our part to ensure that we are preparing our customers. We wanted to take the time to share some tips on how to ensure you are ready when the RACs come knocking at your door:
  • It is important to have a defined process in place for responding to request for ALL departments. Appoint a facility representative to manage the process.
  • It is crucial to respond to the initial request in a timely manner. Most require records be returned within 30 calendar days. Notify all necessary departments immediately upon receiving letter.
  • Keep an exact replica of the paperwork being submitted to the entity requesting the records. It is helpful to know exactly what you submitted and also crucial for utilizing the information in the appeals process should the claim return denied.
  • Always send records certified mail; this will provide written documentation that it was received by the deadline.
  • Always track the claims that are under review so that at a glance you can know where you are at in the process (e.g., “what date were the records sent to the RAC contractor?”). This assists in knowing what is outstanding vs. what has been completed and what are just awaiting result.
  • If a claim results in a denial, inform ALL necessary departments so that an appeal can be filed timely. If you postpone, you are only delaying payment even longer!
  • ALWAYS appeal a claim if you disagree with the decision! It's amazing how many providers just don't file an appeal. 
  • Utilize your Department Heads to assist in preparing a solid appeal. They can assist in providing a stronger argument in why the services provided were justified and should be paid.
  • Do not give up.  If necessary, appeal all the way to the ALJ Level (Administrative Law Judge). 

HealthPro Rehabilitation has had great success in getting claims overturned at this level. You can too, just contact us at www.healthpro-rehab.com.

Kate Davis is the director of business development at HealthPro Rehabilitation. She can be reached at kdavis@healthpro-rehab.com.