For some hospitals, this summer marks the fifth year of dealing with RACs. Nearly $2 billion has been recouped via complex medical record denials, representing the lion’s share of RAC activity.[i] Thousands of audits have been conducted and millions of records have been requested, logged, reviewed and tracked. HealthPort alone averages 39,000 RAC record requests a month.
But what has your hospital learned during the past half-decade? Is your organization any closer to mitigating risk and reducing takebacks?
You certainly can’t stop the RAC tornado from striking, but you can make sure that your organization is prepared for it. Analyzing your historical RAC data is one way to begin building a strong shelter.
Three Questions to Answer
At this point in the game, every hospital should be able to answer these three basic questions:
- How much of your money is at risk?
- How many audits are being held in appeals?
- How are audits impacting cash flow?
Assuming your organization can answer these questions, what have you done with the answers? Have you analyzed your data to assist in coping with the financial impacts of RACs?
Most hospitals already have invested in some type of audit management software. Data mined from audit management systems must be used to target improvement efforts and drive reductions in financial, coding and DRG issues regarding RAC activities.
Surgical denials, coding/charging/clinical documentation improvement, and physician advisors are three areas ripe for rapid process improvement based on RAC data analytics. For example, in the case of surgical denials, data can be used to identify procedures with high volumes of one-day inpatient stays. Organizations should review specific cases to detect opportunities for clinical documentation improvement (CDI), refine treatment plans, and clarify with surgeons whether inpatient stays following these types of procedures are truly justified.
Achieving accurate coding and charging can be bolstered through development of more-specific coding education guidelines. Focus efforts on high-risk DRGs that continually demonstrate high denial rates due to coding errors, and emphasize coding, charging and CDI education in these areas.
Finally, give your CDI team and physician advisors dashboard information on current audit denials. Let them know what types of cases are at risk and tell them about the associated financial impacts. RAC analytics empower CDI professionals and physician advisors to inform and educate clinical care staff effectively, and on an ongoing basis.
RAC audits can impact your accounts receivable and revenue every day. They have been with us for five years, and there is no end in sight. Use the real information and valid historical data within your own systems to make the next five years safer, less costly and more efficient across your entire organization.
About the Author
Dawn Crump is vice president of audit management solutions at HealthPort. She formerly served as network director of audit and compliance at a large regional healthcare system in Missouri.
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