Each regional recovery audit contractor (RAC) differs in its approach when it comes to dealing with providers.
Connolly Healthcare, the RAC for Region C, is fairly transparent when it comes to its interactions. Still, there are a number of things to keep in mind throughout the RAC process, according to Elizabeth Lamkin, president of Dalzell Consulting Group, Inc., in Hilton Head Island, SC.
The following five tips could help providers deal more effectively with Connolly throughout the RAC process:
1. Use the discussion period. The discussion period is a valuable resource for providers looking to avoid the appeals process, and is a low–risk move. The form to open a discussion period isn’t easy to find on the Connolly website, but it is relatively easy to find on the other four RAC sites. “Providers looking to open a discussion period should contact their RAC,” says Lamkin. “In addition, they should also go take a look at the other sites to educate themselves about what is made available to other regions.”
2. Pay close attention to record submission rules. Providers also need to be careful when it comes to the rules on submitting records to Connolly. They are very specific, and if you compare Connolly to the other sites, you will see that there are more fields that need to be filled out, according to Lamkin. While this may seem like more work, precise and complete identification may be to the provider’s benefit down the road, instead of relying on fewer identifiers.
3. Clean up your records. There are detailed rules on the other RAC sites regarding the submission of paper records, such as no paperclips, no staples, etc; while Connolly doesn’t really have those rules. “It might be a good idea for providers to take these suggestions into consideration, since the cleaner the records are, the better,” she says.
4. Designate a point process and test the process. According to Connolly, once records are received, they will send a fax or email to the provider’s medical record contact person, so it’s very important to be clear about who your facility’s point person is, according to Lamkin. “I would suggest that any Region C provider go and download the provider contact form on the Connolly web site and make sure you’ve got it as the right person,” she says. “From there, send an internal test letter to that person to make sure that they receive it, and document how long it takes to arrive.”
5. Don’t let the technical issues bog you down. Before any of the larger RAC issues can affect your facility, don’t let any clerical, front–end issues shoot you in the foot. “As always, if you keep things clean in the front end, it should help the overall process,” she says. “This is certainly a continuing theme, but these things can still lead to big problems for providers.”
Elizabeth Lamkin will be speaking on a Region C RAC Audio conference this September with HCPro. For more information on this audio, stay tuned to HCMarketplace.
James Carroll is associate editor for the HCPro Revenue Cycle Institute.