Providers Leaning on Tracking Software as RACs Press On

James Carroll, May 28, 2010

With the growing number of CMS-approved RAC issues and the impending medical necessity audits on the horizon, the need for RAC tracking software rises daily for providers nationwide.

The software can help lift some of the burden off providers by assisting with a number of steps in the process, including notifying team members automatically of new RAC requests; sending alerts to team members when deadlines are approaching; as well as trending the audits to identify potential problem areas.

Many providers, such as Karen Sagen, revenue audit coordinator for Bellin Health Systems, Green Bay, WI, have had software implemented for more than a year.

Bellin selected Advisory Board's Revenue Integrity Compass, which was initially chosen as a RAC tracking mechanism, but quickly became a tool to be utilized to identify root cause and aid in preventative measures. "Bellin has been actively using the highly developed tools to do preemptive audits," says Sagen. "We've currently identified about $250,000 in underpayments in addition some expected overpayments, which leads our organization to believe they have made a good investment in this tool."

While some providers use the software as a preventive measure, others are using it primarily to track and trend RAC requests. For example, Lori Miller, RHIA, health information manager and privacy officer for Grand Lake Health Systems in St. Marys, Ohio, says it's a great organizational tool.

"Our RAC tracking software definitely makes the [RAC record request] process more efficient, as I'm able to trend a lot easier and submit to AHA a lot easier, since they want all hospitals to submit so they can trend as well," she says.

Now with the impending medical necessity audits, Miller says the software will provide a significant boost to her organization's internal process.

"Medical necessity is beyond me, so that is when I'll certainly start to use a lot of the reminders within the system," she says. "I'll be able to say, 'Okay, I've sent this denial along to someone in another department,' and then they've got 10 days to respond, so the software will remind them of these deadlines and help me to avoid having to do the chasing."

Ultimately the decision of which product to use should come down to exactly how you intend to use it. Grand Lake uses MediReg's ComplyTrack, which is a compliance tracking product they were already using, but are now taking advantage of the RAC tracking functionality.

For Kathleen Hall, CISA, audit and compliance services for Central Georgia Health Systems/Medical Center of Central Georgia, Revenue Integrity Compass was new technology. She says it allows them to be both reactive in their workflow and proactive in data mining their own claims, and would recommend the use of tracking software to anyone.

"Due to the sophistication of the RACs, the ability for providers to analyze their own data is a must," says Hall.

In addition to analyzing their own data, the Medical Center of Central Georgia is also able to interact with other Revenue Integrity Compass users to identify certain areas that RACs are targeting, which in turn helps the facility recognize these areas and make adjustments.

"The ability to openly interact with other users allows everyone to get first-hand accounts of what other providers are seeing and prepare for it before the RACs target you."

For example, the software has helped to examine claims data for medically unlikely edits to see what additional claims are being targeted by the RACs. This data then helps providers make informed decisions, as well as taking practical steps to create system edits and process changes that would mitigate any additional exposure on these areas of concern, according to Hall.

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