HCPro, JustCoding Inpatient - 2017 Issue 4 (January)
Preparing inpatient coders for the RAs 2017 statement of work
January 24th, 2017
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Article Overview
This article discusses the 2017 Recovery Auditor statement of work and the operational and documentation issues it creates for inpatient coding and audit response teams. It is aimed at coding, compliance, CDI, and audit staff who need to understand how CMS changes affect review workflows, documentation readiness, and inpatient claim scrutiny across major diagnosis and procedure categories. The piece also touches on broader review-management topics such as response timing, appeal-related processes, and coordination between clinical and coding reviewers.
Why This Topic Matters
The article helps facilities anticipate how Recovery Auditor activity may change under CMS’s updated framework and what internal teams should focus on to be ready. It is relevant for organizations seeking to strengthen documentation quality, audit preparedness, and review coordination in advance of increased post-payment scrutiny.
Article Sections
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Keys to success
General preparation themes for Recovery Auditor response teams, including organization, communication, documentation completeness, and audit readiness. The section also addresses monitoring of review activity and internal process improvement.
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What will challenge inpatient facilities most as new RAs start up?
A discussion of the main inpatient-facing challenges tied to coding system updates, documentation expectations, clinical validation, and EHR-related workflow issues. It also notes the broader timing and implementation context for the new statement of work.
What You Will Learn
- How the updated Recovery Auditor framework affects inpatient provider operations
- What kinds of documentation and audit-readiness issues the article emphasizes
- Which broad inpatient diagnosis and procedure areas are highlighted as challenging
- How clinical validation and coding collaboration are presented in the article
- What operational themes are discussed for preparing a response team
Who Should Read This
- Inpatient coders
- Coding auditors
- CDI professionals
- Compliance staff
- HIM leaders
- Recovery Auditor response teams
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