Ninety-two percent of hospital healthcare information management directors are familiar with the Centers for Medicare and Medicaid Services' Recovery Audit Contractor (RAC) program, and 40 percent of them expect to owe funds for Medicare overpayments, according to an independent national survey on behalf of Wolters Kluwer Health.
The telephone survey of 175 hospital HIM directors, conducted between June 30 and July 8, found that only 5 percent believe RAC it will have a positive financial impact on their facility due to recovery of funds from Medicare underpayments. Forty-eight percent said they anticipate their facility will come out about even.
Of the total surveyed, 81 percent of the HIM directors reported their facilities are taking steps to improve Medicare claims accuracy. Of this group, the majority reported their hospital has:
- Conducted internal audits (77 percent);
- Implemented a documentation improvement plan (66 percent); and/or
- Created a special task force to examine documentation, coding and billing (57 percent).
Thirty-three percent of hospitals preparing for RAC have installed new software to capture correct documentation, coding and billing, according to the study. HIM directors at medium-sized hospitals reported they are most likely (47 percent) to install new software, compared to 16 percent of those at small hospitals and 35 percent of those at large hospitals. Only 18 percent of the HIM directors taking steps to improve Medicare claims accuracy reported their facility has hired additional coders.
"Hospitals face enormous challenges with the quality and accuracy of their clinical documentation, and the RAC findings confirm this issue," said Arvind Subramanian, president of Wolters Kluwer Health Clinical Solutions. "Many times the documentation is not sufficient to generate appropriate codes."
Coding experts say doctors and hospitals that don't prepare now for the upcoming federal crackdown on Medicare billing could face bills amounting to six figures, referrals to fraud enforcers and possible jail time.
Bolstered by the success of its pilot RAC project, which recovered some $304 million in 2006, CMS will go nationwide to find errant Medicare billing as early as this fall.
How is your organization preparing for the RAC program? Email Senior Editor Diana Manos at diana.manos@medtechpublishing.com.