RAC Audits Under Way, But Hospital Continues to Improve Processes

HealthLeaders Media Staff, October 23, 2009

St. Joseph Medical Center in Houston has been preparing for RACs for months now, says Cucharras Martin, vice president of revenue enhancement at the hospital and chair of the RAC team. But even though she began long ago, it doesn't mean she and the rest of her RAC team are now sitting back and waiting for the audits to begin at her hospital.

"We're still refining," she says. Even though her processes have been in place for a long time, Martin is continuously tweaking them.

Martin's RAC team started by outlining process flows, determining the path RAC correspondence would take through the hospital. The team then assigned roles for everyone involved in the process and determined the necessary timeline for each step. The goal was to have a medical record request fulfilled within 30 days, as opposed to the 45-day deadline set by the RACs.

Martin then decided to test hospital's processes. She took a sample RAC record request letter and, without informing other staff members when it would occur, sent it to her facility. After working the letter through the work flow, the team realized where changes were necessary.

"We found out we really had to have some sort of log where [the RAC team] could sign off on having seen a medical record request," she says. The log they developed is now in a binder that tracks each step of the process, and requires signoff when each step is completed. There is also a comment section where staff members could record any relevant notes. "If there is a denial, we can go back and see what we initially said for each claim. This helps us track and document that records were reviewed [prior to submitting them to our RAC]," Martin says.

The test was so effective that she plans to do it again soon. The first time around her team learned which time frames worked, and which didn't. They also learned where they needed additional resources to make the process effective, such as staff time or something as simple as a binder to track the letter's path. Martin expects additional tests to show her where else the process works well, but also where it still needs improvement, and she knows that now is the time to refine, while her hospital has not yet been audited.

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