On February 11, Healthcare Informatics hosted a live webinar on RAC audits, sponsored by MedPlus. The high attendance and heavy hospital representation was a good indication that RACS continue to be high on the radar screen of providers.
The speaker was Marcia Matthias, corporate director of health information and privacy officer at Southern Illinois Healthcare (SIH), a three-hospital rural health system that includes a critical access hospital. SIH has a high Medicare population, so Matthias assumed RACS would be hitting her hard.
Before going live on her MedPlus system, she had networked with colleagues at other hospitals. “Many hospitals are in a panic trying to figure out how to fight judgments that cold have impact on the bottom line.” She added that especially true now that RACS are nationwide, and horror reports from the pilot states have reached the rest of the country.
Matthias highlighted recent changes to the RAC policy from CMS, including the news on documentation limits set by CMS that establishes a cap per campus unit. Concurrently, there is a new definition of campus unit based on zip code, which benefited Matthias because her three hospitals were now considered part of one facility. Learning the rules and establishing teams were important, but she says it wasn’t enough.
”We knew we needed technology and we wanted a solution that anybody can use.” Using her MedPlus solution to automate the appeal was a success story for SIH—there were no missed deadlines, and staff knew what documents were needed and where, and the status of all appeals. Once a RAC request comes in, it is scanned into MedPlus’ ChartMax, and the entire RAC process is automatically launched and accessible to all members of the team.
Matthias shared some lessons learned: immediately establish a PO Box for the hospital — mail going through traditional channels in the hospital can often take two weeks to get to the right place, and valuable time lost on a RAC appeal. She also recommends tracking all bad debt, so if the hospital has to pay for a claim through RAC it can show if it was written off to bad debt. One last tip (in addition to using a technology solution) was to establish a separate pay code in payroll for anyone working on RACs.
Matthias noted that having all the RAC information available and organized in ChartMax was a big plus when numbers had to be presented to her Board. She also believes that RACS will be a permanent part of healthcare, moving to Medicaid and then to physician offices.
It pays to be ready.