ED. NOTE: This is the fifth in an ongoing series being produced by Carla Engle for RACMonitor.

Deciding how your own internal processes are going to work once the RAC letters start rolling in is probably one of the most daunting tasks we all are grappling with at the moment.

Many hospitals already have mapped out their workflow and are on top of the process long before the letters are set to arrive. Part of that process is to ascertain HOW everything is going to be tracked to make sure that things are flowing in a timely manner and that nothing falls through the cracks.

A big decision in that respect is electing whether to use an automated tracking system to maintain relevant information for audits - not just RAC audits, but all the other audits coming down the pike as well. Obviously, tracking your dates and deadlines throughout the RAC process assures not only that the system moves efficiently and effectively, but that you avoid technical denials caused only by missed deadlines.

Deciding whether to use an outside vendor or create a database on your own demands a review of many factors. Your tracking tool should be able to handle information for multiple facilities and provider types (hospital, home health, physician group) and involve all of your RAC teams in the use of the system. Whichever tool you choose, the authors of the RAC Workbook (Find in RAC University Shop) recommend that the system has the capability to carry out these functions:

• Create and track multiple task assignments
• Attach electronic records and files on both the request and claim levels
• Track the accountability of each step and person throughout the system
• Send e-mail reminders of important tasks and approaching deadlines
• Provide a "belt and suspenders" approach to assuring that all bases are covered in task and deadline assignments
  

Also, through your audit process, you should track the following information:

• Demographic data
  • Facility names
  • RAC audit request numbers
  • Patient account numbers
  • Medical record numbers
  • Patient names
  • Health insurance claim (HIC) numbers
  • Admission dates
  • Discharge dates
  • Total billed charges
  • Total originally paid
  • DRG/APC
  • Principal and secondary diagnoses
  • Types of service
  • Admitting/Attending physicians
    
    
• Requests
  • Number of claims requested
  • Postal/FedEx tracking numbers
  • Names of auditing bodies
  • Dates of initial request letters
  • Dates initial request letters received
  • Confirmation that records were received by RAC
  • Date records sent to RAC
  • Number of pages sent/reconcile claims to request letter
  • Track copying costs vs. reimbursement
    
    
• Determination
  • Reasons for the denials
  • Number of denied claims
  • Results of the audit
  • Types and trends of denials
  • Date review results letter sent and received
  • Date demand letters sent and received
    
    
• Recoupment
  • Dates of reimbursement or recoupment by CMS
  • Amounts of reimbursement or recoupment
    
    
• Appeals
  • Data to decide whether to launch a discussion period
  • Data to decide whether to launch an appeal (and, if so, at what level)
  • For each appeal level:
    • Status of every appeal
    • Basis of appeal
    • Date appeal letter sent from facility
    • Appeal due date
    • Date appeal decision due back from RAC
    • Date appeal determination received
    • Appeal outcome (upheld or overturned)
    • Whether to move to the next level of appeal