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 Hospital Information Systems

Technology can cure RAC audit concerns

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   By Susan deCathelineau, February 2010

HMT

Many providers have found that content management lends itself to automating transactions and managing content in a single location.

Healthcare providers are used to processes. From billing to patient registration to accounts payable, they operate under rules and regulations, policies and procedures. Audits are processes, too. The recovery audit contractor (RAC) program, for example, is an audit. It starts with a record request from the auditor. Upon receipt of the request, the provider has a strictly enforced 45-day deadline to respond. Once the response is received, the RAC can deem an overpayment occurred. Then, the provider has the option to appeal the decision.

What concerns some providers is the thought of returning overpayments. For most, however, the real challenge comes when they learn too late what caused the greatest costs — the audit process itself.

First, there is the cost of managing the process. Much employee time will go into responding to record requests, tracking down the requested information, compiling appeals and managing deadlines. If the evidence is not centrally managed in the first place, the difficulty in accomplishing all the tasks that come with an audit increases.

The next issue is risk. If content is not managed, all the evidence available — or where it is — is unknown. Evidence is either hard to find or it could also be missing altogether. Either way, the organization will miss deadlines — and have to repay Medicare or Medicaid funds.

Both of these additional issues reveal a lesson — organizations cannot be efficient when content-based information is not managed right along with it.

When one healthcare organization in Florida, for example, was hit with the RAC pilot program, it thought it could take it on, no problem. After all, it had been recognized several times as a worldwide leader for using technology to advance patient care.

That mindset quickly changed, however. Hundreds of record requests were coming in monthly. They all had different deadlines to manage. Hiring additional staff was out of the question due to the budget.

With little time to spare, spreadsheets became the quick fix. They were not enough. The organization was slammed with a few hundred thousand dollars in overpayments, not all the charges due to clinical coding errors. Many came as a result of missed deadlines and lost evidence.

Most healthcare providers already know there is a way for processes and their content to be more efficient — technology. For years, they have been using content management, work-flow and imaging technology to better manage their manual, paper-intensive processes in human resources, health-information management (HIM), patient billing and registration.

Now, many providers have turned to these technologies to help them manage audits. They have found that because content management lends itself to automating transactions and managing content in a single location, audits are a good fit. Some of the tasks providers can accomplish with the technology include:

  • Task management: Most content-management solutions will populate a new request once it is sent by the auditor. When every new request enters the system, the designated people on the team are notified. Then, it is automatically assigned to one person to manage. That person can quickly see the deadline, the tasks needed to complete it and the request's expected completion date.
  • Information control: Much of an organization's success with audits rests on its ability to provide all the right evidence. By using the software, the organization's content is managed in a single centrally managed repository. This increases its chances of having the right proof ready in a timely manner. If an appeal is necessary, the provider has proof of when and how the organization responded the first time around.
  • An audit of the audit: With all the new audits springing up, organizations need to perfect the art of handling them. Technology, such as content management, enables providers to track trends associated with their responses. By analyzing this information, providers can get a better idea of where they could have done better and what was causing the problem. So the next time there is an audit, they can improve their response and ultimately their results.

These benefits will go a long way when handling an audit. Keep in mind, though, that one technology cannot do it all. Content management is important in some ways, but, the reality is that a "one size fits all" does not exist. Therefore, focus on finding the right mix of the right technologies that make sense for the organization.

Of course, the tough part is getting the project off the ground. To help, here are a few quick tips to get started:

  • Check out what technology your organization already uses. When budgets were nearly limitless, many providers bought lots of products to support lots of needs (real or perceived, immediate or expected in the future). Some of these could be better used, possibly even for the audits. Look into how these products were originally supposed to be used, how they are being used today and even how other organizations are using them.
  • Talk with your current technology vendors. As technology developers, it is the vendors' job to keep up with how their offerings solve customer business problems. Even if their product cannot directly help, they should be aware of the audits and able to recommend certain products. Also, in many cases, they will have partnerships with providers whose products meet your needs.
  • Start now. With the RAC program and other new audits well on their way, there is no time for thinking "It won't happen to me." Therefore, organizations need to get a better handle on their information and data — and fast. Obviously, each organization has different dynamics that will impact how the audits are managed. Regardless of the differences, providers need to prepare sooner than later.
With the RAC program and other new audits well on their way, there is no time for thinking "It won't happen to me." Therefore, organizations need to get a better handle on their information and data — and fast.

At the end of the day, focus on what can be controlled — the audit process. By taking charge of how it is controlled and the content that goes with it — with the right mix of technology — organizations can eliminate much of the costs that pile up from manually executed and paper-laden audit processes.

Susan deCathelineau, MS, RHIA, is the healthcare manager for Hyland Software.

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Hyland Software solutions:
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Tags:  Hospital Information Systems