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Create a database to manage and track RAC requests

HIM Connection, April 14, 2009

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A comprehensive database is the critical to managing recovery audit contractor (RAC) requests. The RAC team is a good resource for developing a database that best fits the hospital’s needs. Because the database should be interactive and provide appropriate downloads from other systems, the information services department is an important player in developing a database that works best. Note that a shared Excel database can serve the purpose of tracking and trending RAC activities; the majority of hospitals in the demonstration project used this type of application.

Critical elements to capture include:

• Patient demographics
• Date of initial receipt of request
• Dollar pre-preview
• Medical record information sent to the RAC (note any missing parts of the medical record)
• Date medical records sent to and received by the RAC
• Date status (approved or denied) letter received
• Dollar post-review
• Type of denial
• Notice to appropriate person for review of denial
• Agreement or disagreement with denial
• Date, type, and destination of rebuttal letter(s)
• Outcome of denial (e.g., overturned or upheld)
• Dollar post-denial review

The team, the RAC point person, the chief financial officer, and the chief executive officer should be able to access the database and know the status of requests at any time. The database should be able to track and trend activities and to identify issues that need focused reviews. Of course, the importance of knowing the financial picture at all times goes without saying.

Editor’s note: This article was excerpted from HCPro’s book, The HIM Director’s Guide to Recovery Audit Contractors. For more information and to purchase a copy, visit the HCMarketplace.

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