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Tips to prepare for RACs

Recovery Auditor Report, September 18, 2008

You can never be too prepared for the RACs, regardless when they come to your facility. Here’s a starting place to help your facility get “RAC ready”:

• Create a RAC operational team/steering committee at your facility:

• Include members from HIM/coding, PFS, UM/UR, medical director, nursing, nurse auditor, administrative representation, ancillary department heads (therapy, etc), decision support, finance, IT, compliance/legal
  • Identify a physician champion

• Perform GAP analysis to identify risk areas:

• Conduct pre-emptive audits

• Do your own data mining – find your own errors and fix them before the RAC finds them

• Implement DRG validation audits
  • Monitor your upcoding/downcoding
• Assign a nurse auditor to review medical necessity and other identified high-risk areas
• Audit billing compliance
  • Review bill error/correction reports from your scrubber
  • Review claim edits
  • Check incorrect units billed
• Analyze pharmacy/ancillary charges in your chargemaster
  • Verify units of service
  • Verify correct dosages
• Review medical necessity screening process of all admissions
  • Tighten up screening where necessary

Editor’s note: These tips came from The RAC Report advisory board member Tanja M. Twist, director of patient financial services at Methodist Hospital in Arcadia, CA. Twist is the finance chair for the American Association of Healthcare Administrative Management (AAHAM) who has fought Congress on Capitol Hill for better transparency and answers to hospital concerns with RACs. For more tips from Twist, see the next edition of The RAC Report October 2.

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