RAC Demonstration Project Offers Valuable Lessons

Be efficient: As you build your RAC processes, focus on efficiency in your work flows, reuse documents wherever possible and always be on the lookout for ways to streamline your processes. New RAC workflow and documentation tools are coming to market now that can help.

Be aware: RAC correspondence is often sent to the hospital's general delivery mailbox, and many organizations are not set up to alert the right people immediately when this occurs. Payment retraction can be halted if FI-level appeals are filed within 30 days and QIC-level appeals within 60, so make sure your staff are trained to spot these letters immediately.

Be persistent: Especially when it comes to large value claims, we see no reason not to appeal all the way to the FDC level until standards emerge for what denials will and will not be overturned and why.

Be consistent: Many billing organizations find themselves torn between clinicians seeking to provide the safest, highest-quality standards of care on one side and RAC auditors making them pay for exceeding basic thresholds of quality on the other. We are working with a number of organizations to write their own "RAC Rulebook;" setting out well-substantiated standards of care for the organization and using that document to fend-off both groups. The idea is to make both internal and external organizations prove their case against your evidence.

Living in a RAC world
While RAC may create an undue administrative burden on healthcare organizations, and it may wind up triggering unintended consequences, RAC is clearly here to stay. As healthcare professionals we can only work toward smoothing the rough edges as we go and hope for a more just and transparent and system once the kinks are worked out.

In the meantime, healthcare organizations with significant Medicare populations will be wise to get their RAC houses in order and seek professional help when they need it.