Walking through Seattle's Exhibition Hall, you notice vendors hawking RAC services, but there are not nearly as many as you might expect. The AHA list of vendors providing RAC tracking software includes about 30 companies, and I only saw two of them here; of that group, some provide audit services, while others can handle appeals. The hospital attendees don't seem to notice the shortage of RAC service vendors. More than one hospital finance official tells me that "we are taking a ‘wait-and-see' attitude" with the RACs. Another PFS director told me that she was just "RAC'd out."
There was a good RAC education session Monday afternoon, "Preparing For and Surviving A RAC Audit," presented by Elizabeth Lamkin, CEO of Tenet Healthcare's Hilton Head Regional Hospital, and Rudy Braccili, senior director of Tenet's affiliate Conifer Health Solutions.
The room was at capacity with about 175 people filling the seats and lining the back wall when Ms. Lamkin asked how many attendees came from RAC states. Only about five people raised their hands. Incredibly, it seems that there were many RAC novices in the room. As such, it was hard at times for the speakers to find their rhythms because there were so many questions on the basics: RAC history, automated review vs. complex review, timelines of communication, etc.
It was obvious that Ms. Lamkin and Mr. Braccili were not going to be able to cover all of the information they had prepared, but what they were able to get in was great. They focused on practical, helpful information. They discussed key personnel (your physician advisor and compliance officer, who will be invaluable), appeals, key data elements, preparation and self-audit tips.
There was another important message provided here: if you have a strong compliance program in place (concurrent chart review, a competent PA, consistent review of admission status, systems that support compliance), you won't have to be so concerned with the RAC making off with next year's capital budget.
Ultimately, we did run out of time. Mr. Braccili had to skip a lot of slides and went directly into his wrap-up and summary. "The group was very diversified," observed Ms. Lamkin, "and they were hungry for information." Mr. Braccili commented that "there were a lot of questions, and they were all really good questions."
The session concluded on an upbeat note. The message of "plan comprehensively, audit consistently, and appeal effectively" may not have been new to everyone, but it certainly was practical information. The mood in the room was that of hope.
Tomorrow's headlines: Sunny and Warm in Seattle! RACs Not So Bad! Pigs Fly!
About the Author
Dennis Jones is the director of revenue cycle clinical support services with CBIZ KA Consulting Services LLC. His expertise covers a wide variety of topics including managed care, uncompensated care, Medicare compliance, HIPAA and process improvement. He is a recognized speaker having previously addressed the New Jersey Hospital Association, World Research Group and various state chapters of HFMA, AAHAM and AHIMA. His expertise in Medicare compliance has been an integral component of the CBIZ RAC solution.