RAC/ Government Audit Capability
has the capability to manage the entire alphabet
of Government Audits including RACs, MACS, CERTs, Program Safeguard Contractors, MUEs, MICs, ZPICs…
RAC Records Requests | The Document Request tool in Quantum Appeals makes it easy for hospital departments to communicate and gather documentation for RAC medical records requests. Responsible staff members can easily access an automatically generated document request report. Day-by-day prioritization of deadlines can be tracked. Dates are auto-populated for timeliness, supervisory functions, and accountability purposes. Multiple fields are available, so users can request documentation for additional support information needed to successfully appeal a case if it is denied by the RAC.
RAC Appeals | When a claim is denied by the RAC, Quantum Appeals assists reviewers throughout the entire appeal process. Progress can be tracked on all cases undergoing clinical review and the Toolbox in Quantum clues reviewers with possible strategies to address multiple types of RAC denials. Template appeals are available and new templates can easily be added to respond to new issues posted on the Recovery Audit Contractors websites. Staff can easily create correspondence, save correspondence, and upload correspondence. All appeal letters are auto-populated with:
- Letterhead and Date
- Medicare/RAC contractor’s Contact name, and Title
- Patient, Claim, Benefit Information, and the Writer’s Signature
RAC Tracking | Trending Reports for tracking RAC request patterns can be easily generated. For root-cause analysis, Quantum Appeals enables you to track virtually every data field contained within the system. Data fields include, but are not limited to:
- DRG, CPT, & Principal Diagnosis Codes
- Attending Physician & Operating Physician
- Customizable Services, Customizable Locations, & Customizable Levels of Care
- Referring Departments & Responsible Departments or Vendors
- Denial reasons at Every Level of Appeal
All data within Quantum Appeals can be exported upon request using SQL to access the database. Reports in the system can be sorted much like Excel, and also hyperlink to specific cases. If desired, the reports are easily exported to Excel with one click and comma-delimited files can be easily imported into Quantum Appeals.
