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Tip: Use these strategies to get ready for RACs

Patient Access Weekly Advisor, March 17, 2009

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Medicare’s Recovery Audit Contractors have rolled out their permanent program. Here are some tips for your patient access teams to get you ready, courtesy of the white paper, “Recovery Audit Contractors Demonstration Program: Combat the effects of the RAC program with strategic planning,” authored by Kimberly Anderwood Hoy, JD, CPC, director of Medicare and Compliance, HCPro, Inc., Marblehead, MA:

Patient access. Because a form of the RAC focuses on MSP, it is imperative that patient access staff members review this process. Clear policies and procedures based on regulatory guidance need to be reviewed or established to ensure compliance. Facilities should train patient access staff members on the MSP and perform competency testing.

Case management/physician advisors. This group plays a leadership role in the overall RAC process. Case management and physician advisor staff members can be instrumental in reducing the number of inappropriate admissions to the wrong patient status. For example, a patient does not meet InterQual criteria and the physician advisor reviews the case and finds that an observation status would be more appropriate. Therefore, the patient is placed correctly in observation before an inappropriate admission to inpatient status can occur. Policies and procedures can be beneficial in this regard. Additionally, the expertise of case managers is critical to assisting the physician with information to make a status determination.

Charge capture. Diagram and review this element of the process. Charge capture is usually a front-end or revenue-producing department function. As such, it generally revolves around the order entry function or charge entry function of the patient accounting system. This can be an area for unit-of-service errors, wrong charge/wrong patient scenarios, and other items likely to be detected through sophisticated data mining by the RAC software. Charge reconciliation tasks should be a focus when examining this revenue cycle component.

Download this white paper on HCPro, Inc.’s Revenue Cycle Institute Web site.

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