Each year HCPro's Revenue Cycle Institute reports on the experience of providers related to the Recovery Audit Program. This article is adapted from the 2011 Recovery Auditor Benchmarking Report, released in early 2012 and includes additional comparisons of provider experiences since 2009.
To take a proactive approach to the RAC process, you will need to assess your current level of financial risk. You can do this internally or with the help of external resources. There are many good risk evaluation software tools on the market for hospitals and health systems; there are also consultants who specialize in reviewing hospitals' claims for proper coding and documentation to assess overall compliance risk and make suggestions for corrections. Once you identify and quantify your risk, you can begin to take action to mitigate the impact of a RAC audit of past claims and to improve your systems to avoid being out of compliance in the future.
When Nancy Herr, RN, BSN, CCM, manager of utilization review at Liberty (MO) Hospital, started seeing an uptick in RAC audits late in 2010, she knew she needed a way to track activity and share it with others in her facility.
You receive a RAC demand letter for repayment. But wait a minute before you pay up—you might want to take a close look to make sure your facility was really in the wrong. Karen Sagen, managed care leader at Bellin Health System in Green Bay, WI, who has worked in revenue cycle management for the past six years, has developed a step-by-step list of things to consider before pulling out your hospital’s checkbook.