RAC, MAC & QIO
HLS handles administrative appeals in all stages of the governmental payer appeals process. These processes include Recovery Audit Program (RAC), Medicare Administrative Contractor (MAC), and Quality Improvement Organization (QIO). HLS’s approach combines legal and clinical argumentation which advocates medical necessity. Our combined knowledge of the Social Security Act, Code of Federal Regulation and Center for Medicare and Medicaid Services (CMS) Manual and Ruling guidance results in unmatched appeal outcomes. A business relationship with HLS allows for a coordinated process with the hospital’s case management, compliance, and legal departments.