With the nationwide rollout of the Recovery Audit Contractor (RAC) program under way, it’s crucial that hospitals and health systems act now to prepare for the process so that they don’t find themselves scrambling to meet requirements.
I recently spoke with Mollie Diel, product manager at MedAssets, about some “RAC survival lessons” that she has gleaned from facilities that were part of the RAC pilot phase in New York, California, Massachusetts, South Carolina and Arizona.
Diel said that with the right planning and resources, healthcare facilities can not only navigate RAC audits, but may also improve the accuracy of claims management, leading to improved efficiency, more revenue and better financial margins down the road.
Here are Diel’s five suggestions for navigating the RAC process and coming out ahead:
(1) Assess & Analyze – Understanding the potential financial impact of the RAC program is a key step for hospitals preparing for the process, Diel said. As part of their analysis, facilities should: assess their current performance around areas such as coding accuracy and documentation; review previous audit files, including PEPPER and Probe reports and OIG files; and assess records management systems to learn processes, especially for outpatient procedures. Coding accuracy is particularly important, Diel notes.
(2) Educate & Empower – According to Diel, educating staff about the RAC process and putting resources in place to empower staff to address needs is essential for a successful experience. Facilities should: train a RAC team ahead of time to handle research and response; consider tapping vendors or temporary staff to help with processes such as pulling files from offsite; appoint internal RAC champions; work with physician advisors and administrators on strategy and procedures; and put a communications infrastructure in place to ensure proper communication across the organization regarding RAC.
(3) Organize & Outline – The more organized facilities are up-front, the better prepared they will be to handle RAC requirements. Diel said healthcare facilities should: identify the individuals who will drive the process internally; outline and build processes for gathering documentation, developing tracking mechanisms, delivering requested records, reviewing and responding to demand letters, tracking recoupments and refunds and directing and tracking appeals; and establish a plan for communicating with internal staff as well as the RAC contractor.
(4) Align & Automate – Diel said facilities in the pilot program found that manual processes were not sufficient for addressing RAC needs. She recommends that facilities implement an automated RAC tracking solution that ensures only valid claims are audited, provides a mechanism for escalating deadline reminders, develops tracking mechanisms, facilitates departmental communication, identifies systemic trends and weaknesses, manages appeals and allows for capturing and monitoring data that can be shared.
(5) Measure & Maintain – Finally, Diel says measuring progress and outcomes is critical to identifying areas of risk and opportunities for improvement. She said facilities should aggregate data and measure by service, denial reason, DRG, coder, dollars recouped, dollars refunded, state of appeal and total financial impact to organization.