Recovery audit contractors are creating apprehension among healthcare providers. The threat of an audit means increased reliance on efficient, accurate care and billing information. Can vendors help? Providers are going to have to be able to collect data in a way that they can prepare for those appeals,” said Paul Pitcher, director of financial services at KLAS. But the market for RAC products remains somewhat undeveloped as providers await complex audits and more information on what to expect. “We’ve reached out initially to the providers to say, ‘Tell us about your RAC solution,’ and we’ve gotten a lot of response saying that they aren’t doing that yet,” Pitcher said. Experts say identifying risks and knowing data are essential parts of the RAC preparation process. Vendors that offer solutions and services to make these processes easier are likely to rise to the top of the market.
Two Trends to Watch
Paul Pitcher, director of financial services at KLAS, sees these industry trends affecting Medicare’s Recovery Audit Contractor program in the coming year:
- Software solutions: While hospitals aren’t necessarily going to need a dedicated enterprise system for RAC preparation, software solutions that integrate with existing systems could emerge as the path providers will take.
- Data mining: RAC preparation means learning where data resides and how it can be extracted for an audit. Data mining solutions could become an integral part of organizations’ plans for RACs.
VENDOR SHOWCASE
Bloodhound Technologies
ConVergence Point
ConVergence Point is a hosted claims editing service that can process a claim against 16 million edits across total patient history in sub-second response time. All ConVergence point edits are open-sourced and based on national standards and can be filtered to exactly match a payer’s reimbursement policies. Further, ConVergence Point provides a Web portal for providers to see edits and correct claims before submission.
Claimtrust, inc.
InSight RAC
InSight RAC is a fully hosted, Web-based solution designed to help hospitals minimize RAC exposure and give them the best chance for appealing RAC denials. InSight RAC features specific workflow and tracking tools with proactive deadline alerts, includes appeal letter templates with proven winning arguments and provides robust reporting capabilities designed by RAC experts specifically for navigating the multiple levels of RAC inquiries and appeals.
Contact: Jay Roche, j.roche@claimtrust.com, 615.869.4030.
Healthport
RACPro
RACPro is a combination of HealthPort’s tracking and workflow management technology, release of information services and fulfillment and consulting services – all designed to improve RAC workflow, increase efficiency and mitigate RAC risk. RACPro enhances the RAC management process and further expands communication capabilities so that healthcare facilities can respond and manage RAC audits effectively.
McKesson
McKesson RAC Solutions
McKesson provides a suite of solutions to manage the RAC audit program. Risk Assessment enables organizations to quantify potential revenue loss or gain, then take action to implement resources and solutions to mitigate risk. Audit Management provides organizations with comprehensive workflow and tracking tools, along with automated chart release. Additionally, automated packaging of medical records and supporting documentation for electronic submission to the RAC is provided. Finally, Risk Avoidance includes processes optimization plans and tools to minimize risks and potential losses in future audits.
Contact: www.mckesson.com/RACsuite.
Medassets
Claims Auditor for RAC
Claims Auditor is a Web-based solution that streamlines and automates cumbersome processes to help hospitals facing audits as part of the CMS Recovery Audit Contractor (RAC) program. Claims Auditor audits historical claims to assess risk and uses an interactive workflow and customized reporting to aid in the appeal of RAC audit findings in a timely and efficient manner. It also integrates to MedAssets’ coding and reference research tool and helps identify areas for improvement, such as compliance and reimbursement issues. Claims Auditor is compatible with the American Hospital Association’s RACTrac and has achieved Bronze level certification from Executive Health Resources.
Contact: 888.883.6332, solutions@medassets.com.
Quadramed
RAC Sentry
This new tracking tool enables healthcare organizations to electronically capture audit and appeals data while streamlining RAC processes. RAC Sentry monitors due dates, stores audited patient records and correspondence and creates work queues for chart review.
Relayhealth
RelaySettlement
RelaySettlementAudit Manager Service for Providers manages the audit processes around the Medicare Recovery Audit program. The solution identifies risks so providers can correct mistakes before they occur.
VHA
VHA RAC Readiness Assessment
A comprehensive RAC risk assessment and analysis program that helps hospitals analyze data, assess potential risk, reduce vulnerability and improve their clinical compliance and documentation processes. VHA Clinical Documentation Improvement Program: This VHA program helps hospitals improve the accuracy, clarity and completeness of their documentation, teaches proper coding and promotes relationships between patient care and inpatient coding teams.
Contact: RACinfo@vha.com, www.vha.com/documentationimprovement.
USER REVIEWS
“Lee Memorial relies on HealthPort to manage the up-front steps of RAC compliance to HealthPort: receiving request letters, retrieving records, scanning documents and sending copies to the RAC. HealthPort also conducts an initial record review. By outsourcing this step, our staffing burdens are dramatically reduced, and HealthPort is chiefly responsible to meet initial RAC deadlines. HealthPort also provides us with a robust RAC database. Also used to track appeals, RACPro supports our internal review of cases, and extensive RAC reporting for financial risk analysis and appeals outcome auditing.”
– Stanley Padfield, system director, HIM & patient information privacy officer, Lee Memorial.
“Senior Whole Health wanted a scalable, adaptable, efficient and real time claims editing system that could be placed anywhere in the adjudication process, and that’s what we got with Bloodhound Technologies’ ConVergence Point. From the get-go, Bloodhound Technologies was able take our data and immediately respond with a comprehensive analysis.”
– Mike Levoshko, CTO, Senior Whole Health, a voluntary healthcare plan for low-income seniors in Massachusetts and New York.
