June 22, 2009

RAC Record Requests Alone Can Bury You

By

ernieBy Ernie de los Santos

 

Get your RAC teams ready now, because the medical record requests alone can bury you.

 

That's the message I took from the Healthcare Financial Management Association's ANI conference in Seattle.

 

The Tenet Experience

 

The session presented by Tenet Healthcare included a brief overview of the RAC program. Following that was an outline of Tenet's response to RAC requests and audits. Tenet chose to have patient financial services be the division responsible for responding to the RACs, including coordination with clinical and non-clinical staff.

 

Fortunately for Tenet, all of its facilities have an installed EMR. Issues did arise from some requested records that predated the EMR system, but the local HIM departments seemed capable of handling them manually. PFS also was responsible for involving CM/UR with issues involving incomplete records or record reviews, for determining any rebilling possible and for coordinating efforts to make reports available throughout the system.

 

Each hospital was tasked with supplying complete support for its PFS department, including the services of a hospital-based RAC task force made up of representatives of HIM, coding, DPS, HCO, finance, CMO, CM/UR and of course PFS. The hospitals also were responsible for providing education for physicians and their practices.

 

Tenet used several multi-disciplinary teams at each site to support all this activity. Their titles are fairly self-explanatory, and included the following:

 

  • Corporate RAC Steering Committee
  • Hospital-based RAC Task Force
  • Medical Record Provision Workgroup
  • PFS Workflow Team
  • PFS Medicare RAC Tracking & Reporting Team

 

RAC Tracking

 

Perhaps the most useful details in the presentation concerned the data the company tracked during the RAC process.

 

Demographics Tracked:

 

  • Facility
  • RAC audit letter ID#
  • Account No.
  • Patient name
  • Medical record No.
  • HIC No.
  • Admit & discharge dates
  • Total charges
  • DRG assigned
  • PxDx (frankly, we also would suggest all secondary Dx & ICD codes be tracked)
  • Admit/attending physician
  • LOS

 

RAC Request Data Tracked:

 

  • RAC firm name
  • Date of RAC record request letter
  • Date requested records due to RAC
  • Date records sent to RAC
  • Date records received by RAC
  • Method of record delivery (with tracking number & status)
  • Type & page/file count of records sent to RAC
  • Copy/duplication cost of records sent
  • Delivery cost of records sent
  • Hospital invoice
  • Date of RAC review result letters
  • Date of RAC demand letters
  • Date RAC demand letters received

 

Dynamic RAC Data Tracked:  (Audit Category)

 

  • Request for records
  • Payment correct (result of review was negative for errors)
  • Underpayments (just a number count with a running total in dollars)
  • Overpayments by type
    • Not medically necessary, service (service deemed not necessary)
    • Not medically necessary, setting (setting: OP billed as IP)
    • Discharge status conflict
    • Accounts not combined
    • Incorrect units charged

 

We would advise perhaps adding more types of overpayments, such as those rendered due to various types of coding errors, and in particular those cited as being "not medically necessary due to lack of documentation."

 

If all that data and the need to track it accurately don't make you dizzy, then I don't know what will (perhaps you should be writing articles about RAC tracking?)

 

What to do if you didn't get to attend ANI

 

Some of you attended ANI last week; some did not. The trouble with national conferences like ANI (besides the cost and time demands tied to attending) is that the topics have to be defined in advance. Usually, as with ANI, the topics are set for summer presentations in the previous fall. While the presentations can be and are actively "adjusted" right up to the week of the conference (and to be fair, they sometimes do insert special and timely "issues" sessions), there is no way to update them after the fact. That is, they are simply snapshots of moments in time, or of the world as it existed at the moments in which they are held. Of course, as you well know, our world of reimbursements is not set in stone, and is nothing if not fluid. Be that as it may, it is not the fault of the conferences nor the presenters - it just is what it is.

 

Education and Training

 

Regardless, I can say that almost every session included a list of recommended actions for providers looking to prepare further for RACs and other auditors. Invariably included in such lists was this mantra: "educate and train." It was nice to have so many vendors and providers alike agreeing with us - you need to train your staff.

 

That statement is almost a maxim these days. The trick is to keep providing everyone current information, not outdated information. Enter RAC University...

 

RAC University Offerings

 

Now, the various conferences you can attend do offer useful information. But again, they only can reflect single moments in time. RAC University's online offerings, however, are fluid. And not only can you get very timely information from our eCourses, but you can take them home with you, take them to your facility for everyone to experience, and even repeat the experience, all at no additional  charge.

 

Remember, RAC University's eduTrax eCourses are licensed to a purchaser's entire facility, not just a single user or workstation (which is the typical license restriction you'll find in all the small print on just about everyone else's CDs or audio conference recordings).

 

Also, RAC University's eduTrax eCourses are updated automatically as necessary, whenever changes occur in the reimbursement environment - not that this ever happens much, right? (Grin)

 

Pick 5ive Offer

 

While flying back from Seattle, we decided to offer a new package to RACMonitor readers - RAC University's Create Your Own Conference, or PICK 5IVE. You choose any five eCourses from our stable of information-packed eCourses, all for the great price of just $500.

 

Want to make up for the fact that you missed the ANI? Well, here's what we suggest for RAC education:

 

  • RAC Appeals (coming soon, includes an updated version coming in July)
  • Clinical Documentation Series - choose one of these:
    • CHF, Pneumonia, Sepsis, or UTI
  • Observation vs. Inpatient Status (or just the one on Cardiac Services)
  • Documentation & Coding Hot Spots
  • Excisional Debridement

 

Want to order this package?  Call us at this number: 1-866-829-6612, Ext. 706

 

OR -- Visit this page for a list of all available eCourses, including short previews of each.

 

And of course, you can always check out our special offer to get nine of our most popular eCourses.

 

Assigning responsibilities and tracking these records will be crucial if you hope to achieve any measure of success.

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