Session Objectives
Tips for how to handle automated reviews
Recommended RAC reporting
Top five lessons learned by Sharp HealthCare
Automated RAC Audits
According to CMS, these started many months ago, but providers seem to be seeing these just as of recent
Immediate identification is the key» RAC contractors still seem to be struggling with sending letters;
check your RAC website frequently» There are situations where you may not have received a letter
but you get the remittance (N432) indicating the recoupment
• Dollar amount at risk (Medicare original payment)
• Dollar amount of net gain/loss (difference between the Medicare original payment and any takeback/ repayment including any additional rebill)
• Type of audit (complex vs automated)
• Reason for audit, audit result
• Facility, service area distinctions
• DRG – billed, paid, revised/new
Reporting Data ElementsReporting Data Elements
Alerting
Establish alerts for critical deadlines such as Medical Records in process
Med Recs In Process #
Alerting
Alerts are visual within the dashboard and e-mailed to appropriate responsible parties
Med Recs in Process #
The Alert System has analyzed your Med Recs in Process # Key Indicator and found that it meets your alert criteria for alert – Med Recs in Process # goes above 0.
This alert has the following data constraints: System=All , Facility=All , Age from Request Date=31-45 ,Patient Type=All , Account ID=All .
Med Recs in Process #
Lessons Learned Lessons Learned #1#1
Minimal data entry» Inconsistent capture of data
elements, format of account numbers
Flexibility to access all data elements
33
Lessons Learned Lessons Learned #2#2
Get to know your RAC contractor» Call, communicate often» Watch the website
Lessons Learned Lessons Learned #3#3
Don’t underestimate the impact of the demand (automated) audits» Is your CDM up to date?» Billing system edits current?» CPT frequencies built cleanly and
functional
Lessons LearnedLessons Learned #4#4
Identify how you are going to scan and store your records» How are you going to capture
all images and records you actually sent?
» Are there security concerns when linking from one system to another?
» Need all related documents, both clinical and administrative, in one place