RAC Management For Hospitals

 

The RAC Audits are back.  Long after the Medicare RAC programs began, it continues to receive huge amounts of press and notoriety primarily because of the RAC audit’s contingency-based compensation. Like most contingency based organizations, Medicare RACs are paid a percentage of the improper payments they identify, which often times creates an incentive for the RACs to be overly aggressive. However, despite the negative depiction of the Medicare RACs, the Affordable Care Act (PPACA) of 2010 continues to expand the RAC program to now encompass Medicaid.

Under the Medicaid RAC program each state must contract with at least one Medicaid RAC for the identification of overpayments and underpayments and for the recoupment of overpayments. Medicaid RACs will be paid on a contingency fee basis for the collection of overpayments, but each state will determine how to pay Medicaid RACs for the identification of underpayments. The Centers for Medicare and Medicaid Services (CMS) has formally directed states to implement their Medicaid RAC programs by April 1, 2011.  With the new onslaught of Medicaid RACs coming how will you stay ahead of auditors and minimize financial risk?   

Let Interpoint Partners help you develop and execute comprehensive Medicare and Medicaid Recovery Audit Contractor (RAC) strategies to preserve your good revenue.   With RAC Shield, providers have a completely integrated solution that makes risk assessment easy.  RAC Shield is a real-time RAC workflow solution designed specifically to help hospitals manage key workflow processes, and comply with current Medicare RAC and Medicaid RAC collection standards.  RAC Shield pulls data directly from any patient accounting system into a user friendly interface making it easy to manage deadlines, share and update information, and research details of each identified RAC account. In addition, RAC Shield utilizes advanced business intelligence and reporting capabilities to track progress, monitor efficiencies, and simplify the intricate RAC appeals process.

 
Proven Expertise in RAC Audit Management

Intepoint has been providing cutting edge technology for years that enable hospitals manage all facets of quality and performance. Providing RAC management and analytics, Interpoint’s business intelligence platform is the most effective path to Medicare and Medicaid RAC management.

Interpoint brings together the expertise, services, and technology to achieve the highest level of transparency, collaboration and expertise between care providers and RACs. Interpoint has the expertise to create and implement a technology strategy that will help accomplish your Medicare and Medicaid RAC technology initiative – from building the work lists and appeal tracking process, analytical capabilities, to developing vital reporting, forecasting and financial models to monitor outcomes and manage risk. The result is a technology enabled RAC system that achieves optimal outcomes across your organization.

  

RAC Audit Management Features Include: 

  • Imports active A/R and historical zero balance accounts, including payment and adjustment transactions
  • Integrates work driver metrics to track and manage the complex and time-sensitive appeal process
  • Identifies accounts for which documentation should be reviewed
  • Generates automatic reports to identify clinical process changes required to prevent future audits
  • Exposes high risk in-house or recently discharged RAC patients through level of care analysis
  • Immediate access to appeal status and outcome reporting
  • Worklists can be integrated with HIMS and case management to help facilitate a centralized approach for appeals
  • Registration quality workflow alerts staff when critical fields are invalid to complete an accurate registration prior to or at the point of service
  • Integrated A/R workflow designed to increase staff efficiency collecting cash in the business office

 

Click here to have one of our RAC consultants contact you regarding our solutions.