Missing RAC Records: Another Snag Thrown at Providers

James Carroll, June 10, 2010

In the increasingly stressful realm of RAC coordination the last thing providers need is additional complications to add to the workload. Unfortunately for them, the latest wave of RAC obstacles brings just that.

A number of providers across different RAC regions have been sending records to their RACs via verifiable means (i.e., FedEx), and having their RACs come back and deny receipt of the records, despite the signatures on file.

"Currently we are working with DCS (Region A RAC) to determine the whereabouts of 36 out of 161 recently sent," says an anonymous provider from a large hospital in Boston. "Shortly after, PRG-Schultz came back and informed me that only 9 of the 36 records were actually missing. It makes me wonder what they are doing."

In this case, this provider is working with DCS / PRG to try to come to some type of resolution. The [provider's] HIM department is reproducing the nine records to send again, and a one-week extension was granted to the hospital to get the records back; but unfortunately this may turn into a finger pointing game, says the provider.

"This puts undue strain on an already extremely busy department," she says. "The thing that makes no sense is that they have some records (from the same box), but not all of them."

Regrettably for providers nationwide, this isn't just a DCS issue. Karen Sagen, revenue audit coordinator for Bellin Health Systems, Green Bay, WI, has sent records which have been signed for, but CGI has been unable to locate them. Sagen, who is currently waiting for CGI to return correspondence, says that providers need to keep these process issues in the forefront.

"When having these issues, notifying the Regional CMS RAC liaison, the regional RAC audit director, and your regional Hospital Association is key to getting these issues corrected over the long term," says Sagen.

In the case of at least one provider, Sagen was right. Joni Baker, RHIA, CCS, external audit coordinator for Spectrum Health System in Grand Rapids, MI, had two records requested for one patient, both of which were for the same issue. While it may have looked like the same record —an outpatient chemotherapy record —it was not.

Baker returned correspondence by highlighting the two different dates of service on the record that had been requested, and even submitted a cover letter indicating why it may have looked like one record when it was in fact two.

"Upon checking the Web site for receipt of records, only one remained marked received, so I continued to call and e-mail, even copying Scott Wakefield (Region B CMS liaison)," she says. "Finally, after weeks of phone tag, I got to talk to a live person and I re-stated everything in my cover letter, and one week later I received a call back, stating that they received the chart and they would close the issue."

Interestingly enough, the review results letter arrived just one week after the call and closing of the issue.

James Carroll James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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