Getting RAC Ready

Providers can also appeal any claims they believe were wrongly denied by a RAC or CERT. The process for RAC appeals has been widely discussed, but providers can also go through the appeal process for a CERT denial. "It's not just a de facto takeback," Levitt says.

In addition, CERTs will still use OIG statistical methodology. "They're still bound to that just like the RAC is—for example if a RAC wants to extrapolate," she says. "Everybody is held to the same statistical standard, such as the OIG statistic program, RAT-STATS."

RAC Preparations Well Under Way
Budgets are tight, but it seems that many healthcare providers are aware that setting aside resources to prepare for RAC audits is nonnegotiable.

HCPro's Revenue Cycle Institute examined this concept as a part of its recent nationwide survey of RAC readiness. The study, which was released recently, garnered more than 700 participants from all four RAC jurisdictions. The respondents hailed from various size healthcare providers: 25% came from hospitals with fewer than 100 beds, another 25% came from hospitals with more than 400 beds, with the remaining 50% falling in between. Approximately 14% of respondents had taken part in the RAC demonstration project.

"Respondents seem to have their RAC preparations well under way, although it's not surprising that they are struggling with resources to devote to preparation," according to Kimberly Anderwood Hoy, JD, CPC, author of the RAC Preparedness Benchmarking Report and director of Medicare and compliance at HCPro, which is also the parent company of HealthLeaders Media.

"Providers appear to be crunched for resources to provide to the RAC team, with 50% indicating that departments are just absorbing RAC costs into their current budgets," Hoy wrote in the report. "This may be driving the relatively high number of respondents using homegrown software and tools for risk assessment. Software for tracking requests is a bit of a different story, with providers split roughly equally between homegrown methods and third-party vendor software."

Amounts facilities budgeted to deal with RACs varied greatly, according to the survey. Reported amounts averaged between $200,000 and $600,000, although some survey participants mentioned smaller budgets of $15,000 to $40,000 (often used primarily for adding staff members to deal with the increased workload).