I didn’t have a chance to see this presentation at the Craneware Revenue Integrity Summit, but I saw the slides after the event and thought many readers of this site would find them useful (or someone at your organization will find them useful). This is an important decision for every hospital. Hopefully these slides will help you better make the decision.
Lori Brocato is Director of Audit at HealthPort. With more than 15 years in health care technology, Lori serves as HealthPort’s resident government and third party audit expert, sharing educational information and best practices with health care facilities via Webinars, media interviews and industry articles. Additionally, she is the AudaPro product manager for HealthPort and authors her own blog, Audit Insights, on the HealthPort website. Lori is also a monthly contributor for RACMonitor, an online knowledge source for healthcare providers. She is RAC certified by the Medicare RAC summit and a member of HIMSS and HFMA.
In my most recent blog post here, I presented some helpful hints for reducing the impact of typical RAC audits. In a nutshell, I emphasized that moving toward a centralized, more fully automated, paper-free environment would soften the blow of the ever-increasing administrative burden of audits. Maximizing technology, I concluded, will bolster efficiency and enhance organization, the traditional keystones of corporate success.
But now, to complicate matters, RACs have widened their nets. Nearly all hospitals have deepened their relationships with physician practices, and the RACs have taken notice. Hospitals must now be vigilant of audit activity surrounding the physician practices and take appropriate steps to mitigate the interruptions and expense wrought by additional inquiries.
RACs Make First Move into Practices
Two RACs have already promised upcoming reviews focused at physician practices and medical groups. RACs have also promised to expand E/M coding, the most likely source of overbilling or duplicate billing as hospitals accustom themselves to working in concert with these new business partners. Additionally, RACs now often request physical copies of medical records. In the past, automated reviews based on data analysis of claims an remittance information were the norm. To make matters worse, long-standing, regional health plan auditors are also getting in on the action, requesting and reviewing patient records.
Obviously, RACs have made some game-changing enhancements to their efforts to locate and retrieve billing errors and overcharges.
Here are four ways hospitals can level the playing field with RACs as it relates to their owned or affiliated physician practices and medical groups; minimizing the impact these inquiries have on staff and budgets.
Knowledge is Power –Provide your physician practices with access to RAC managers, historical program information and revenue impact reports. Inform them of key RAC targets for medical groups and deliver real, practical tips on how to mitigate risk.
It’s a Team Effort – Interview each practice administrator to identify and track all RAC activity and record requests. Explain the importance of centralization and incorporate practice administrators into the organization’s overall audit program.
Connect the Dots — Create a specific workflow or use database and tracking technology that follows a specific process to manage audit requests across both inpatient and outpatient settings; including physician groups and medical practices. Open the lines of communication with practice administrators to ensure all RAC requests are properly communicated, logged and processed.
Learn from Mistakes — Conduct internal audits and track and review the results regularly. Take educational action based on findings. And finally, use data from internal audits and key reports to validate that any and all vulnerability are identified and fixed.
Audits are disruptive and a real threat to your revenue, and they are growing in frequency. The trend towards stronger hospital-physician relationships enforces the need for hospitals to take action, bring physicians into their centralized RAC strategy, and ensure everyone’s revenue is protected.