Are you getting everything you need from your RAC solution?
Intersect Healthcare clients universally describe VERACITY as the most robust and comprehensive RAC solutions available. Timely filing of records and resubmitting data are key components in overtuning technical denials. In 2006, 22% of CMS submitted claims were denied. Of those, only 40% were resubmitted, most often for failing to meet established deadlines. Your electronic tracking tool should provide an efficient process and effective communication between departments.
The authors of The RAC Workbook recommend your solution 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
Through the 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
The following elements also exist within the reporting tool to ensure that the workflow is flowing:
Attachments
-
Attach copies of medical records, correspondence, and appeals directly to the claim
Communication
- All verbal and written communication (calls, e-mail, any correspondence), performed both internally and between the facility and the auditor
Tasks
- Who is responsible for what, and when is it due?
- Make sure task assignments are communicated quickly to those responsible for completing them, and that management is kept informed
Timelines
- What is soon due and when?
- How can I manage my team and keep them informed that big work demands are coming up?
Financial impact and risk to the organization
- Reports that indicate at-risk dollars in each level and corresponding statuses
- Trending and analysis that shows patterns, both with providers and RACs
Compliance
- Indicators of reportable events
- Broader compliance issues that need further investigation and auditing
Duplicate claims
- Are you tracking duplicate claims to ensure that another auditing body hasn’t already reviewed this claim?
Other audit types
- Are you tracking other types of audits? MICs? ZPICs, QIOs, MACs, CERT, etc.
VERACITY covers all but two items on the checklist (tracking copy reimbursement & trending), however both are already planned for future release versions. If you are currently keeping track using Excel or Access, you are NOT going to receive the return on investment you WILL receive from an automated process.