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Assessing and quantifying your risk for RAC recoupments

Recovery Auditor Report, September 8, 2011

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Editor’s note: This article was excerpted from the new HCPro book, “The RAC Toolkit for Hospitals and Health Systems,” by Amanda W. Berglund, MS, MBA and Elizabeth E. Lamkin, MHA. Lamkin will be signing copies of the book at HCPro’s Medicare Compliance Forum, which takes place September 19 and 20 in Chicago.

The purpose of the book is not to highlight every issue that RAC will consider for overpayment, but to arm providers with tools to assess their own organization’s systems and processes and to mitigate the loss of revenue and risk of overpayments. It is the responsibility of the RAC committee to stay on top of all issues approved for their regional RAC.

To take a proactive approach to the RAC process, you will need to assess your current level of financial risk. You can do this internally or with the help of external resources. There are many good risk-evaluation software tools on the market for hospitals and health systems, and there are also consultants who specialize in reviewing hospitals’ claims for proper coding and documentation to assess overall compliance risk and make suggestions for corrections. Once you identify and quantify your risk, you can begin to take action to mitigate the impact of a RAC audit of past claims and to improve your systems to avoid being out of compliance in the future.

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