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RAC audits aren’t yet as bad as predicted

Charles Cataline, senior director of health policy at the Ohio Hospital Association, said only a few issues have been approved so far for RAC audits, but many of them are complex. Audit activity level is varying greatly from hospital to hospital.

Cataline was speaking at the Fifth National Medicare RAC Summit, held March 9-11 in Washington, D.C., during a roundtable session.

Teaching hospitals “are drowning in activity,” while some critical care hospitals have not had any review requests, Cataline said. The big emphasis in Region B is on documentation, he noted.

“It's never been more true that if it isn't written, it didn't happen,” he said. “Documentation is key to winning an appeal.”

Kathy Reep, vice president of financial services for the Florida Hospital Association, said audits are underway in Region C, but “we're just not hearing the thunder.”

“Ten percent of our denials are being appealed, and 86 percent are overturned,” she said. “So we are very successful. In addition, many of the hospitals who aren't appealing are tending to agree with the RAC findings.”

Many were concerned about receiving requests for 500 documents during an audit, but in Region C most of the requests have been for no more than 100 documents at a time. Only one third of Region C hospitals have reported any audit activity, Reep said.

Tish Hollingsworth, director of reimbursement for the Kansas Hospital Association in Region D, said the number of audit requests has been slow, but activity is now picking up. “It seems the auditors are doing more every 45 days,” she said.

Stewart M. Presser, vice president of the Greater New York Hospital Association, said Region A’s contractor has indicated it can’t handle a request for 500 documents. Some hospitals that have had audits are not hearing back within the required 60 days.

Presser emphasized that the process has been “very slow.”

Cataline advised hospitals to take an aggressive approach and start preparing for an appeal when the “additional documentation request” letter arrives. Be ready to demonstrate a “clean shop,” he said, and be aware of any documentation issues.