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Patient access managers must be ready for RACs

Patient Access Weekly Advisor, September 24, 2008

The “better late than never” theory will not work in a defense against Medicare’s Recovery Audit Contractors (RACs). And that certainly goes for patient access managers.

Access managers must prepare for RACs now, says Tanja M. Twist, director of patient financial services at Methodist Hospital in Arcadia, CA.

“I strongly urge hospitals to take advantage of this lull in the RAC process to perform gap analyses within their facilities to find their areas of risk before the RAC does,” says Twist, who directs the patient access manager at her facility. “Anything hospitals can find and fix on their own will result in not only lowering the number of RAC denials, but also will reduce your vulnerability for a false claims suit should the RAC identify a trend in your data.”

But what specifically do patient access managers need to anticipate and start fixing now to help their facilities defend against a RAC?

“From an access point of view, hospitals should be performing analyses on their one-day-stays vs. observation cases and medical necessity denials,” Twist says. “In analyzing the data, they will likely identify several key admitting physicians who are driving the problem accounts. Using a physician champion, hospitals can work with their physicians to reverse the trend. Again, it is important to find and fix these deficiencies before the RAC does.”

For more tips for patient access managers to become “RAC ready” from Twist, please see the next edition of Patient Access Weekly Advisor Wednesday, October 1.

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