Introduction. Centralizing and simplifying your RAC processes is of the utmost importance so you can avoid the 10 most common RAC mistakes.

Transcription

1 TOP 10 RAC Mistakes

2 Introduction Constrained assets. Limited time. Sound familiar? These are problems encountered on a daily basis by many of us in the health care field. We are constantly tasked to find ways to do more with less, and when it comes to audits, this added pressure from simultaneous fronts can lead to mistakes. Centralizing and simplifying your RAC processes is of the utmost importance so you can avoid the 10 most common RAC mistakes.

3 10 Not taking ownership. First, decide who will be the accountable owner for ensuring a timely response for audits. Next, ensure that all data surrounding the audit is captured and tracked in a timely fashion. Finally, let the numbers speak for themselves in establishing the audit team s staffing and budgetary needs. Tip Using audit management technology, such as AudaPro, allows for audit tracking, reporting, and analysis.

4 9 Too many dabblers. Decentralized, casual audit managers: are unlikely to become experts have inconsistent processes take longer to process requests take longer to process audit results A centralized team, on the other hand, quickly becomes the experts. Tip Use resources like the RAC Monitor to help your team become subject-matter experts.

5 8 Becoming dependent. Do not let be your only source of audit management communication. Everyone has an horror story: the failure to respond, the lost conversation, the misplaced attachment. Plus, it is entirely too easy to accidentally and completely delete a record. Be sure to engineer alternative methods of communication and safety valves into your audit procedures.

6 7 Excluding billing and revenue cycle from the audit team. Tracking and reconciling government audits is a complex process. While it is important to create a centralized team, it is equally important that you do not attempt to do everything yourself. Engage your billing and revenue cycle management staff members and utilize them as part of your centralized audit management team. They are the experts.

7 6 Failing to respond to denials in a timely fashion. Diligent focus on the timely submission is required in order to mitigate revenue take backs. Once medical record information is sent to the auditor, don t let appeals float away. Use the discussion period quickly and have an internal appeals team. Develop a process so you can more effectively utilize the discussion period, respond to audit requests and pursue appeals in a timely fashion.

8 5 Ignoring the lampposts. Audits are visual outcomes of your clinical documentation and billing processes and, as such, become lampposts to illuminate your problems. Use results to look ahead while also guiding today s clinical documentation improvement (CDI) efforts. Tip Reports such as Medicare s highest-prices surgeries and the RACTrac surveys can help you identify future RAC targets.

9 4 Not controlling costs. Time-and-motion studies demonstrate there are formidable costs associated with audit compliance. RACs demand full-time equivalents (FTEs), paper production, postage, shipping, tracking, monitoring, and appeal management. $ $ $

10 3 Not following up on key audit trends. It is important to stay ahead of the game, or the result likely will be a failure to follow up on key audit trends. Remain vigilant to see what is coming down the pike; if you are only looking at regional issues going forward, you are likely to miss the big picture. Issues in New York, Florida or California, for example, will trickle down to rest of the country and, ultimately, your region. Tip Attend local and national compliance conferences to keep abreast of audit trends.

11 2 Not understanding who the auditors are. Currently, regional contractors are changing. RAC responsibilities have been realigned and we are waiting for final contractor determinations. Once announced, it is important to know your auditors. AUDITOR The auditors differ; they all do not follow the same processes. If you do not know their procedures and are having difficulty finding out about their procedures, contact them directly. Learn processes for each auditor and clearly define them for your team. Tip Find current audit contractors on the CMS Recovery Audit Program site.

12 1 Not centralizing your audit management program We have all experienced it in various aspects of our lives and work: Too many cooks in the kitchen. Instead, it is better to have a few chefs and call in specific experts when you need them. This is especially important for larger healthcare organizations. Centralizing your RAC and audit management processes Tip allows you to simplify workflow while still ensuring that you are getting properly reimbursed. Read about centralizing audits in HFM Magazine.

13 Conclusion When you centralize your RAC and audit processes, data is more congruous, less mutable and more valuable for root cause analysis and risk analysis, which gives you solid footing to continue to accelerate your clinical documentation improvement efforts.

14 AudaPro AudaPro is a powerful, comprehensive audit management tool designed to relieve the stress related to managing the many audits that can negatively affect your facility s revenue. Our unique technology and integrated release of information facilitates the automation of medical record request fulfillment, appeals management, tracking, reporting, and communication. Additionally you have access to real-time financial compliance and dashboard features to capture critical data. Learn more about AudaPro today.

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