3. Log all audit request letters, responses, appeal fi ndings and outcome letters into a centralized audit tracking system.
4. Store all audit information, correspondence and medical record documents electronically; scan or upload into a common area for reference.
5. Develop standardized reports to communicate with the “C” level and other stakeholders.
Detail for reporting Management reports are required for each type of audit or
across audits. T is is particularly important for organizations using a centralized audit management approach. T e team overseeing the process must be continuously updated with key information, such as number of active audits, potential lost revenue and appeal status. Custom reporting should also be available by audit or across all audits without vendor support or extensive programming requirements.
Compatibility for AHA RACTrac According to the AHA, being RACTrac-compatible simply means that a vendor has “created a mechanism in their claim- level RAC audit tool that will aggregate RAC experience data at the hospital level that is consistent with AHA RACTrac survey questions.” Compatibility hastens the quarterly RAC reporting process to the AHA and ensures that nationwide data, like that referenced above, is complete and accurate. Most vendors have achieved this designation; a complete
list of RACTrac-compatible vendors is available online at the AHA RACTrac website.2 In addition, the AHA hosts quarterly webinars to review survey data. From these webinars, provid- ers are able to keep abreast of RAC trends, target issues and program concerns. Beyond these key criteria, organizations can make the most of their audit software investment by using the following best practice implementation considerations.
Implementation considerations When audit software implementations go awry, there are two key points of failure to evaluate and correct: system work- fl ow and user education. Understanding the root causes and workfl ow choke points
is important to solving the most visible problems associated with audit management. Most systems allow for assignment of specifi c tasks and responsibilities within the audit process, with email notifi cation to users (individuals or groups) within the system. When the application is not functioning properly, system workfl ows should be checked and faulty assignments corrected within the application. User education is another area of concern for most audit management software vendors. Organizations should develop standard terminology to use when entering data in the sys- tem. All users should document review and denial reasons in the same way, using the same vernacular. By keeping
documentation consistent across the organization, reports remain correct, data accuracy is maintained and cases can be easily identifi ed. Finally, the entire audit management department should keep up to date on new review issues published by the RAC and, in some cases, the Medicare administrative contractors (MACs). Updates are available on their respective websites. Subscriptions to applicable CMS newsletters and industry list servs are another way for staff responsible for audit oversight to remain up to date with impending threats and audit risk.
Maximizing audit software capabilities T ere are two features available within audit management
software applications that dramatically improve appeal suc- cess rates and reduce the administrative burden associated with audit processing. T ese include the ability to view and approve submissions before they are sent to the audit entity and electronic delivery of documents directly from the audit management application. A review-and-approve queue allows organizations to view,
approve or disapprove every record before it goes to the ap- propriate audit contractor. By ensuring that all documents within the audit package are correct, complete and support the care delivered, organizations increase the rate of positive response by the RAC. T is feature is especially important for medical necessity denials, which are the most costly audit cases for providers to process. Electronic delivery of documents directly to auditors is another feature worth implementing. Technology is currently available in two fl avors: CMS’ esMD project or a direct portal connection to the payer. A direct portal is a single organi- zational conduit to all audit entities. It can be shared by an organization’s HIM business offi ce and any other department submitting records to auditors. Up to 50 percent reductions in associated costs can be seen by using electronic delivery tools, as they remove signifi cant amounts of paper from the audit process. More information about both of these options can be obtained from the CMS website or individual websites of approved health information handlers (HIHs).
Conclusion Audits tax an organization’s human resources and increase operational expense. When poorly managed, audits result in revenue loss. T e use of technology streamlines audit processing while also reducing labor cost. Solutions are proven. Second- generation technology is available. If your organization has not yet implemented an audit management solution, now is the time.
1. American Hospital Association, RACTrac Survey, third quarter 2012. Available online at: http://www.aha.org/advocacy-issues/rac/ractrac.shtml
2. American Hospital Association, RAC Audit/Tracking Tool Vendors, updated January 23, 2013. Available online at: http://www.aha.org/
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