Let's face it—dealing with Recovery Audit Contractors RACs is an albatross around the neck of susceptible providers. But for diligent hospitals that have anticipated RACs since the demonstration project, the situation is far less dire.
A recent update to the evaluation of the RAC demonstration shows that HealthDataInsights (HDI), the RAC for Region D, had the highest percentage of claims overturned on appeal, which shows that, like providers, HDI is not perfect.
With this in mind, consider the following tips to help develop a conscientious approach from start to finish, which can augment providers' chances of success throughout the RAC process.
- Know your number limit when it comes to medical record requests. Based on the current formula, limits are based on the servicing provider's tax identification number and the first three positions of their ZIP code; and set at 1% of all claims submitted for the previous calendar year, divided into eight periods (45 days), according to Jennifer McManis, RHIT, the compliance/privacy officer at Bozeman Deaconess Hospital in Bozeman, MT.
- Develop an audit tool. When it comes to medical records and their related claims, this is a must, according to McManis. "The tool should focus on appropriate DRG assignment, appropriate assignment of complications/comorbidities, appropriate principal procedure assignment; and the coding source," she says. "In addition, it should address discharge disposition validation and medical necessity validation."