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Facilities avoiding self-audits

The RAC Report, October 30, 2008

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Facilities can avoid a visit from a Recovery Audit Contractor if they self-disclose using protocols for “internal audit assessments,” says William Malm, ND, RN, partner at Health Revenue Integrity Service LLP.

However, Malm says, the buzz in the industry is many hospitals nationwide have not performed these self-audits because “they figure that the amount of the takebacks, if there are any, will be less than all the self disclosures and costs,” Malm says. “They do not wish to really look that hard at themselves as most of their operating margins are only 1 to 3%. The cost of internal reviews and disclosures they feel sucks up that amount, and they just are better off fighting what others catch.”

Malm suggests one way to begin the RAC defense is to build a database for data mining. It will help you catch trends -- does your physician do admits too often rather than filing them as outpatients? Look for patterns of noncompliant behavior, Malm suggests.

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