Recovery Audit Contractor
Technology can cure
RAC audit concerns
Many providers have found that content management lends itself
to automating transactions and managing content in a single location.
By Susan deCathelineau
ealthcare 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 pro-
vider 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
record requests were coming in monthly. They all had
late what caused the greatest costs – the audit process
different deadlines to manage. Hiring additional staff
was out of the question due to the budget.
First, there is the cost of managing the process. Much
With little time to spare, spreadsheets became the
employee time will go into responding to record requests,
quick fi x. They were not enough. The organization
SHOWLINE tracking down the requested information, compiling
was slammed with a few hundred thousand dollars in
appeals and managing deadlines. If the evidence is not
overpayments, not all the charges due to clinical coding
centrally managed in the fi rst place, the diffi culty in
errors. Many came as a result of missed deadlines and
accomplishing all the tasks that come with an audit
Most healthcare providers already know there is a
The next issue is risk. If content is not managed, all the
way for processes and their content to be more effi cient
evidence available – or where it is – is unknown. Evidence
– technology. For years, they have been using content
is either hard to fi nd or it could also be missing altogether.
management, work-flow and imaging technology to
Either way, the organization will miss deadlines – and
better manage their manual, paper-intensive processes
have to repay Medicare or Medicaid funds.
in human resources, health-information management
Both of these additional issues reveal a lesson – organi-
(HIM), patient billing and registration.
zations cannot be effi cient when content-based informa-
Now, many providers have turned to these technolo-
2500 Tamiami Tr N
tion is not managed right along with it.
gies to help them manage audits. They have found that
Nokomis, FL 34275
When one healthcare organization in Florida, for ex-
because content management lends itself to automating
ample, was hit with the RAC pilot program, it thought
transactions and managing content in a single location,
it could take it on, no problem. After all, it had been
audits are a good fi t. Some of the tasks providers can
recognized several times as a worldwide leader for using
accomplish with the technology include:
technology to advance patient care.
Task management: Most content-management solu-
That mindset quickly changed, however. Hundreds of
tions will populate a new request once it is sent by the
30 February 2010 HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com
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