Unlock the Secrets to a Successful RAC Audit Process With Three Keys

Little mistakes can mean a big price tag. “University of Michigan Health System Overbills Medicare by $6.2 Million,” and “OIG Tags Carolinas Medical Center for Incorrect Billing” (over 1.7 million) are just two recent headlines regarding paybacks to Medicare as a result of RAC audits.

Over the last five years, $200 billion has been spent by Medicare on errors. That’s $40 billion each year of preventable mistakes made by healthcare providers. Avoidable errors produced the reason for the creation of the Recovery Audit Contractors (RAC) Program.

Now audit managers are struggling to prepare for what a RAC audit will hold because every year and each case are composed of many different elements. The audit process often steals valuable work resources that could be better spent in billing and collecting, all the while leaving wasted productivity and financial losses in its wake.

What if you could unlock the process secrets of RAC audits? What if there were keys that would allow you to productively respond to audit requests and even prevent audits?

While there may not be a super key to prevent RAC audits, there are keys that can be used to unlock a workflow process that leads to success. Three of these keys are:

1.  Organized and Calculated Process

2. Technology

3.  Collaboration

The key of an organized and calculated process

The advantage of being aware and organized can be the difference between lost or gained revenue. Creating a working relationship with your RAC audit company will empower you to understand your target audit categories. It will also allow you to gain an extensive understanding of the audit process and goals. By maintaining a good working relationship with the RAC auditor your organization can obtain the information needed to prevent audit recoveries.

A good way to keep this relationship solid is through the security of a calculated process. This will allow timely and accurate responses to your RAC auditors. An additional benefit for your organization is an estimation of recovery prevention or loss that is easily reportable to your financial branch. This information will allow the importance of these audits to speak for themselves.

The key of technology

It’s no secret that new advances in technology are happening overnight. The leaps and bounds workflows gain from automation are undeniable. It enables better tools to help track your RAC audits, maintain compliance and more. Which do you choose?

The power of technology creates a prompt accurate response to audits as well as the financial information needed to report the calculated risk of future audits. The right technology better equips you to navigate through any new processes, tools and requests that an audit may require.

Security, flexibility, collaboration and ease of operation should be the top issues to consider when adopting new technology. The average staff member should be able to navigate the software with minimal training and ease. Choosing the right automation will allow your staff to focus on audit issues!

The key of collaboration

Creating clear communication between all parties involved is an obvious necessity and crucial for success. The right technology not only encourages collaboration but also enhances areas where it is lacking. Common areas of focus for RAC audit collaboration are between financial branches, medical experts, employees, chief financial officers, your RAC auditor, and your RAC audit team.

Collaboration with your financial branch is especially important because the feedback given to it is vital for success and must be beneficial to the inner workings of your organization. Essentially your employee overhead and cost for outside assistance must become a valuable asset.

Report methods to gain this information should be seamless and organized. Specific reports should be in place to determine the cost benefit to all allocated resources dedicated to the audits. The technology chosen to help with this process should be able to calculate these statistics.

Automated reminders and notifications should be utilized as well to ensure no preventable mistakes are made. This well-defined information helps to provide an open channel of communication with your CFO.

Medical experts are additionally significant. Their availability to discuss and evaluate the medical efficacy of the audit focus can be essential to your RAC auditor better understanding how your organization works. This clear communication from the right resources can help to prevent recoveries and future audits.

Developing a RAC audit team that meets at least once a quarter (monthly if needed) is vital to your success. This team should consist of all parts of the organization that influence the RAC audits. It is important that this meeting has the information needed to focus on prevention as well as current results. Being prepared is the only way to succeed!

Unfortunately, RAC audits are not completely preventable, but having the necessary tools can prevent unnecessary administrative and financial losses. As healthcare policy continues its development, new regulations and stipulations are just behind the next door. Taking an organized calculated approach, utilizing automation advantages, and maintaining clear collaboration will prepare your organization for RAC audit success regardless of what lies behind the next door.

Lori Intravichit is CEO, Sunlit Cove Healthcare Consultants Lori has more than 25 years of experience in healthcare administration in senior management roles within both provider & payer organizations. To learn more about the company's services visit https://www.sunlitcovehealthcare.com/.