Revenue Cycle

Top 10 lessons learned from the RAC demonstration program

Recovery Auditor Report, May 14, 2009

The RAC demonstration project has come and gone, but many providers learned valuable lessons during the process. Consider the following advice from providers and other experts who have experienced RACs first-hand, and lived to tell about it.
  1. One of the most important lessons Tanja Twist, MBA/HCM, director of patient financial services for Methodist Hospital in Arcadia, CA, learned from the demonstration project was the need to diligently track and monitor all correspondence to and from the RAC. “This goes beyond tracking the date you send or receive the actual documents (e.g., determination letters, medical record requests and appeals) or send the medical records, but should include tracking the receipt of the documents by the RAC to ensure you are responding timely.” Send everything via certified mail with a return receipt, she suggests. And make sure you are educating your entire facility—not just the mailroom—on what the RAC documents will look like so that correspondence will get to the right person or department. “Don’t assume that because you are able to identify a recipient for correspondence that the RAC will get it right every time,” she says.
  2. Tracking appeals was the single most important way to survive a RAC audit because it allows you to prioritize your appeals, says Stacey Levitt,RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City. “This way you can spend your available time where you get the biggest bang for your appeal effort.”
  3. Having a strong physician advisor program—not just having the concept on paper, but an available and active physician participant reviewing and interceding when appropriate—is critical for surviving RACs, according to Yvonne Focke, RN, BSN, MBA, revenue cycle director at St. Elizabeth and St. Luke Hospitals in Covington, KY. “Having such an advisor strengthens your compliance program which is more defensible when appealing cases, especially once they reach the Administrative Law Judge," she says.
Editor’s note: Click here to read the remainder of the top 10 lessons learned.

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