Physician Practice

Four tips for HIM pros on dealing with RACs

Physician Practice Insider, May 26, 2017

It’s easy to be overwhelmed by the volume of recovery auditor (RAC) requests and lose track of cases during the appeals process. Use a proactive approach to stay ahead of the RACs:

  1. Review and refine processes — Implement effective processes to maximize reimbursement and minimize takebacks. Conduct internal reviews and audits, review all clinical documentation, and continually refine workflow processes for these cases.
  2. Document and track — HIM’s most important role is to document and track every step of RAC reviews for every case. Use spreadsheets or an IT application in conjunction with a vendor partner.
  3. Increase collaboration — Effective RAC risk mitigation extends beyond your designated RAC team. Increase communication and collaboration among RAC teams, coders, and CDI specialists. All should work together to reduce RAC risk.
  4. Continually develop staff — Team members must also become RAC experts. This includes education and training on how to deal with ever-changing program parameters, meet tightening deadlines, and manage a deluge of auditor requests. RAC specialists must determine which audit data is most important and be able to uncover data integrity issues in collaboration with the audit and coding teams.

Editor’s note: This item was written by Lula Jensen, MBA, RHIA, CCS, director of product management for MRO in Norristown, Pennsylvania. A full article appears in the May 24 HIM Briefings on Revenue Cycle Advisor.


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