RAC audits – What you need to know

I recently penned an article for Health Management Technology about the Recovery Audit Contractor, or RAC, program. Based on what I heard at the recent HIMSS show – the frequency of audit letters is dramatically increasing – I think now is a good time to dust it off and share it with you. If you’d like to see the entire article, I’ve included a link at the end of this post. Here goes:

Many providers have found that content management lends itself to automating transactions and managing content in a single location.

Healthcare providers are used to processes. From billing to patient registration to accounts payable, they operate under rules and regulations, policies and procedures. Audits are processes, too. The recovery audit contractor (RAC) program, for example, is an audit. It starts with a record request from the auditor. Upon receipt of the request, the provider has a strictly enforced 45-day deadline to respond. Once the response is received, the RAC can deem an overpayment occurred. Then, the provider has the option to appeal the decision.

What concerns some providers is the thought of returning overpayments. For most, however, the real challenge comes when they learn too late what caused the greatest costs – the audit process itself.

First, there is the cost of managing the process. Much employee time will go into responding to record requests, tracking down the requested information, compiling appeals and managing deadlines. If the evidence is not centrally managed in the first place, the difficulty in accomplishing all the tasks that come with an audit increases.

The next issue is risk. If content is not managed, all the evidence available – or where it is – is unknown. Evidence is either hard to find or it could also be missing altogether. Either way, the organization will miss deadlines – and have to repay Medicare or Medicaid funds.

Both of these additional issues reveal a lesson – organizations cannot be efficient when content-based information is not managed right along with it.

When one healthcare organization in Florida, for example, was hit with the RAC pilot program, it thought it could take it on, no problem. After all, it had been recognized several times as a worldwide leader for using technology to advance patient care.

That mindset quickly changed, however. Hundreds of record requests were coming in monthly. They all had different deadlines to manage. Hiring additional staff was out of the question due to the budget.

To read the rest of the article, click here.

Susan deCathelineau

Susan deCathelineau

With more than 20 years of healthcare technology and operations leadership experience, Susan deCathelineau is a leader in providing management and consultant services for Health Information Management, Revenue Cycle and Electronic Medical Record strategies. Most notably, she was responsible for the successful enterprise-wide OnBase implementation at Allina Health, which included the integration with the Epic electronic medical record (EMR) initiative. In her current role at Hyland, deCathelineau is responsible for developing and implementing a global strategic vision, to ensure that OnBase Healthcare solutions and services earn customer loyalty and deliver operational excellence. Prior to joining Hyland in 2006, deCathelineau was director of corporate information services at Allina Health System and vice president of product management at QuadraMed. She holds a bachelor’s degree in health information management from the College of St. Scholastica, and completed her master’s degree in health services administration at the College of St. Francis. She is currently Hyland’s vice president for global healthcare sales and services.

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