Minimize RAC Takeback

Though the hospital is looking to take its files electronic in the future, Hilton Head Hospital currently uses paper medical records. So meeting the demands of the RAC requests means that reviewing each of the records, writing the responses, and tracking the results requires approximately three hours collective time per case for Hoops and Redler.

Since going through their initial audit and successfully recovering the majority of their funds, Tenet has changed some aspects of the process. Now when Hilton Head receives a RAC audit request, Hoops will contact the main Tenet office, which has since centralized the filing and tracking systems, and it will help with the process.

When to expand your tech
For larger health systems or those hospitals handling greater volumes of Medicare claims, adding audit management software to track RAC audits and provide forecasting can give facilities a great ROI. Depending on the level and breadth of technology needed, software ranges from a few thousand dollars to five figures, but it will likely pay for itself after one difficult audit.

In Dallas, Cheryl Robbins, RHIT, CCS, associate director of coding and registry compliance for the Parkland Health and Hospital System, is banking on more advanced technology to get through Parkland's RAC audits.

"We have multiple locations and we know we just can't do it with an Excel spreadsheet," says Robbins. Last summer, Parkland Health, which includes 995 beds and numerous community- and school-based clinics, signed on with MRO Corp. to use its Audit Tracker Online program. The King of Prussia, PA.-based company created a Web-based payer audit management program that provides managerial oversight and reporting capabilities for all incoming audit requests and denials.

Robbins explains that the hospital pays a monthly base licensing fee, a flat rate of $3,000 to upload and track documents on the MRO Web site. The only item the facility needed to purchase was a high-speed scanner. "We liked that it was a flat rate and that the startup costs were relatively low," she notes.

Diane Cahalan, RHIA, a director in PricewaterhouseCoopers' Health Industries Advisory Practice who worked with 10 hospitals in New York during the demonstration project, notes the importance of tracking data.

"Once you get to the higher levels of the process, it becomes more difficult to track cases and it takes them longer to get back to you; it's easy to lose track of a record," she says. A sophisticated system can track records as they go through the audit and appeals process, as well as help facilities identify and address inconsistent documentation.

Whether a facility opts for a basic upgrade to its existing auditing and monitoring program or adds advanced technology depends in part on estimates of potential loss from an audit. Finance leaders should continually run projections on their RAC exposure and determine if the cost of purchasing advanced technology is merited.

—Karen Minich-Pourshadi