Revenue Cycle

RAC talk: A few minutes with Nancy Beckley

Recovery Auditor Report, January 27, 2011

Name: Nancy J. Beckley, MS, MBA, CHC

Title: President

Company: Nancy Beckley & Associates LLC

Quick-hit RAC background:

Nancy has worked with providers on understanding the RAC process and how to incorporate CMS-approved issues into routine monitoring and auditing activities. Her focus has been on working with rehab providers at hospitals, SNFs and outpatient venues including private practice, comprehensive outpatient rehabilitation facilities and rehab agencies.

What are some (or just one) of the most common errors you’ve seen hospitals make when it comes to the RAC process?

The hospitals that I have been in touch with seem to have refined their system over the past year of RAC activity with complex reviews of DRG validation and now medical necessity. The RACs rolled out their issues in a slow but steady pace in 2010 allowing hospital RAC teams to refine their process and work out system bugs. Where I see some problems is in the post-acute and non-hospital providers where RAC activity has been minimal, if nonexistent, and there is a sense that after the RAC roll-out sessions in 2009 that things have “fizzled”. On the long-term care side, much of the RAC risk is associated with the RUG rate, which in large part is driven by therapy. I don’t think that industry has addressed how the facilities and their contracted therapy providers should address the RAC risk contractually, or share in the financial risk for any recoupments.

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