Revenue Cycle

Hospital shares experience, tips for surviving RAC audits

Recovery Auditor Report, June 25, 2009

One of the best ways to prepare for a RAC audit comes in learning from survivors. Elizabeth Lamkin, CEO of Hilton Head Regional Hospital in South Carolina, offered guidance to HFMA’s ANI conference attendees on June 15 on how to prepare for RACs.
As part of the RAC demonstration program, Hilton Head Regional, a Tenet Healthcare hospital, was audited and subsequently went through the appeals process.
During the audit, Lamkin says the hospital was very detailed in its record keeping. "We kept a copy of everything we sent. We also reviewed every chart for compliance with our physician advisor, and were confident we had medical necessity so we appealed," she says. On the 31 charts involved in the audit, Lamkin says the hospital received 22 back saying they had been denied. "They were bounty hunters. They want your scalp," she says.
In preparing for RACs, Lamkin says it is essential for hospitals to have the right physician advisor in place to monitor medical necessity cases. At Hilton Head Regional, the chief of staff works part time as a physician advisor. "If done correctly, a physician advisor will be your saving grace," says Lamkin. "If the patient does not meet medical necessity, the call goes to the physician advisor, so it means your case managers and that doctor have to get along."
The hospital also started using a call center two years ago to advise physicians on the proper bed status of patients presenting in the emergency room. The hospital also does real-time billing audits and compliance checks on the front end.
Editor’s note: This article was excerpted from the HealthLeaders Media article “From HFMA: Preparing for a RAC Audit,” by Michelle Ponte.

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