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Hospitals' RAC audits usually managed by one compliance employee

Hospital audits conducted through the Centers for Medicare & Medicaid Services’ Recovery Audit Contractor (RAC) program are usually handled by compliance departments and are generally managed by a single full-time employee (FTE), according to a new survey from the Health Care Compliance Association (HCCA).

The HCCA made these determinations based on the results of a web-based survey of 418 healthcare organizations ranging in size from one employee to more than 5,000 employees.

Key survey findings include:

[See also: Compliance: Expert insights]

  • Two-thirds of respondents said RAC audits were the responsibility of their organization's compliance department.
  • Fifty-seven percent of all respondents reported a sole FTE handled RAC audits, 27 percent of all respondents reported two FTEs handled RAC audits and 64 percent of organizations with more than 5,000 employees reported three or fewer FTEs handled RAC audits.
  • Fifty percent of respondents reported that compliance department budgets for this fiscal year were unaffected by government initiatives, 5 percent reported that budgets decreased and 10 percent reported significant increases; and
  • Seventy-seven percent of respondents from organizations with fewer than 250 employees reported  they used consultants to assist with RAC audits compared to 40 percent of organizations with more than 5,000 employees.

“Compliance is not a complex concept,” said Roy Snell, HCCA’s CEO. “Auditing, monitoring, investigating, reporting, educating, disciplining, risk assessment and legal analysis have been done forever. The problem is that most health systems have these functions structured in a silo and the entities do not communicate well.”
“They are now creating better-coordinated compliance programs,” added Snell. “Before, everyone did their little piece, but when it came to fixing and preventing problems, it just didn’t happen. Noone had ultimate accountability or authority. Now we are essentially taking all these things we did before that were in silos and saying one person is going to have the responsibility of coordinating the resources.”

Follow HFN Editor Rene Letourneau on Twitter @ReneLetourneau.

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