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See Latest ArticlesRegulatory Issues: Recovery Audit Contractors and Their Impact on Case Management
Lippincott's Case Management, 09/30/09
Terra SM et al. – The practice of case management continues to evolve, especially in the acute care arena. As the cost of healthcare continues to rise, checks and balances will be put into place to control or reduce these costs. Primarily, these checks and balances are regulatory in nature and have been met by case management departments as an additional task added to their current responsibilities. One of the most labor–intensive roles of these regulatory changes is the advent of the Centers for Medicare & Medicaid Services permanent RAC program. This program is likely to result in retrospective review and submission of appeals for a number of short (1–3 days) acute hospital stays paid for under the Medicare program. It is also likely that the case management department will be assigned the bulk of the clinical work related to RAC.
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