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RAC News & Updates
Nancy Hirschl & Healthport
 HealthPort has partnered with Nancy Hirschl, a widely recognized industry expert on the Recovery Audit Contractor (RAC) expansion.
Working together with Nancy, HealthPort helps hospitals plan for, track and deal with RAC audits. We are committed to your success under Medicare’s RAC program. Check this page often for the latest news, education and free webinars about RAC.
CMS discusses limits on medical record requests by RACs
During an AHA member call today to discuss the nationwide rollout of the permanent Medicare recovery audit contractor program, Centers for Medicare & Medicaid Services staff announced limits on the number of medical records the RACs will be allowed to request from providers.
For inpatient claims, the maximum number of records RACs may request will vary by the hospital's national provider identifier and will equal 10% of average monthly Medicare claims. The RACs will not be able to request more than 200 records in a 45-day period for both inpatient and outpatient claims combined. Providers with more than one NPI may face a unique record limit per NPI; however, CMS staff said they plan to provide further clarification on this policy.
Earlier this month, CMS announced the names of the permanent RACs and revised plans for the nationwide rollout. Hospitals in the first phase of the rollout may begin to receive requests for medical records or reimbursement of overpayments as early as December. For more on the RAC program, visit
http://www.aha.org/aha/issues/RAC
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HealthPort Pulls Together Expert Panel to Discuss RAC
AHIMA National Convention Sets Stage for Real-World Advice on RAC
Preparedness
HealthPort will
host 2 informative sessions about the RAC program and HealthPort's new RACPro Solution
at this year's Association
for Health Information Management Association's
(AHIMA) Convention and Exhibit in Seattle, Washington. In partnership
with Nancy
Hirschl, RHIT, CCS-P, President, Hirschl
and Associates, the panel will share real-world experiences from
Medicare's RAC demonstration program with an
emphasis on how organizations can prepare for auditors, mitigate their
risk for revenue reduction, and manage the administrative burden of RAC.
Panel members include Ms.
Carol Richardson, MA, RHIA, Director of Health Information
Management and Corporate Policy official from Adventist Health in
California; Mr.
Lane Edenburn, Executive Vice President and General Council of
Health Data Insights (HDI); and Mr.
Stanley Padfield, RHIA, HIM Director for Lee Memorial Hospital. HDI
is one of the four original RACs that participated within the original
pilot program. In addition, it was announced yesterday that HDI would be
part of the permanent RAC expansion.
Click Here to view our press release
Click Here for details about Product World and to register
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RAC Permanent Program
On October 6, 2008, CMS announced the names of the new national RACs:
- Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York.
- CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.
- Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
- HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.
Click Here for More Details
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CMS Appeal Update to 3 Year Evaluation
CMS Update: Appeal Update of previously released 3 year RAC Evaluation Report
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CMS Announces New Timeline for Permanent RACs
At a meeting of regional, state and metropolitan hospital executives in Washington, D.C., Centers for Medicare & Medicaid Services Office of Financial Management Director Tim Hill announced a revised timeline for the nationwide rollout of the permanent recovery audit contractor program.
Click Here to View the Presentation by Tim Hill
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This just in from the Centers of Medicare and Medicaid Services (CMS):
Press Release: New Report Shows CMS Pilot Program Recovering Nearly $700 Million in Improper Medicare Payments
Report: The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-year Demonstration
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Nancy's RAC Executive Update Presentation
Nancy recently spoke at a HealthPort sponsored event. You can view her RAC Executive Summary in the player below.
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Next RAC announcement expected within weeks
Next RAC announcement expected within weeks. Expect news about CMS awarded RACs, start-up and final implementation dates.
Medicare expects to make their next announcement about RAC audits in June 2008. Based on recent activity and national feedback, we expect to hear final word regarding CMS RAC awarded contracts, implementation dates, and any final rules and regs related to RAC operations. If you are attending HFMA's ANI conference in Las Vegas, join me for an executive update on Monday, June 23rd.
Providers in the RAC Pilot program have identified extensive financial and administrative issues regarding the internal needs faced in meeting RAC demands including:
- Incorrect coding;
- Insufficient physician documentation;
- Unsupported medical necessity;
- Inappropriate patient status designation;
- Clerical support staffing (medical record location and photocopying);
- RAC process and outcomes tracking;
- Internal coding, case management, and billing auditing; and
- Rebuttal and Appeals processing.
Which of these issues have been the most difficult to manage for your organization?
RAC audits come with hefty back-office, record management and staffing price tags.
We've heard feedback from many providers in early RAC states that the administrative burden associated with keeping track of RAC audit activity is costing thousands of dollars a month. Responding to inquiries, finding and photocopying medical records, and tracking communication with the RAC takes time and money. There are overwhelming manpower costs to comply with auditor demands. Some organizations have assigned a RAC Manager to the task. Technology to track all the records is minimal with most organizations relying on Excel spreadsheets. What is your organization doing to manage the administrative burden associated with RAC audits?
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