Muse Matters - Spring 2009 - (Page 39) RAC is Coming to US Hospitals: HOW to Survive • If an account was previously reviewed by your Medicare payer, it cannot be audited by RAC. So, I suggest placing a flag on accounts to alert your RAC team of this fact. • The RAC audit company is required to reimburse the hospital 12 cents per page for printed copies of submitted records and should pay within 45 days. You should not need to bill the RAC company for these fees. I suggest tracking the expected reimbursement for the records until you have confidence in the RAC process for payment. Records can be submitted on a CD vs. hardcopy. • Setting up your RAC Review Team doesn’t have to be difficult. Team members should be strong and knowledgeable. The number one key is to have a multidisciplinary team in place for RAC review. • Your RAC liaison is a key member of your team. Inform your RAC audit organization of the name and address of your primary RAC liaison, so all request letters and documents are sent to one person. The duties of your RAC liaison may become full-time as the program progresses, so choose wisely for this key position. Some sites have elected an HIM staff member, some a Case Management member and others someone from PFS. This liaison must have the backing and support of senior management and report to said management on a monthly basis. • American Hospital Association(AHA) will be a key player for the RAC rollout. Your state’s AHA and RAC audit company will work together to educate providers using methods such as town hall meetings. Another advantage that AHA will bring to the table for your site is a survey question program they will launch to secure data from all hospitals (whether AHA members or not). AHA will compile all data and work for the good of all hospitals regarding RAC issues. Your organization will want to participate in these activities. • The appeal process is a five level process, and each level has its own time frame and requirements. Interest can accrue if you are not successful in your appeal. The most recent statistics reveal that 22.5% of RAC determinations were appealed, and of those appealed, 34.0% were successful. You can optimize your chances for success. Read Transmittal 144, which provides details on the Appeals Activity Form (CMS-2592). Track timelines for each process and keep proof, such as the envelopes the complex records request came in, a copy of all documents sent for audit as well as the certified receipt of the records sent showing that the records were received and received on time. Familiarize your team will all RAC deadlines and requirements, track deadlines and if necessary, ask for an extension on cases that requires more review time. • The process for appeals for RAC determination is largely the same as the standard CMS appeals process for MAC (Medicare Administrative Contractors) claims. One significant exception is that all RAC first-level inpatient appeals will be handled through the fiscal intermediary that processed the claim; for MAC claims, all first-level inpatient appeals are handled through the Quality Improvement Organization. This article has just a few of the facts that your team needs to be aware of to prepare for RAC audits. Be sure to check out CMS RAC FAQs too. It is a great source of info, and it gives you the ability to ask your own questions, too. continue SPRING 2009 MUSE INTERNATIONAL 38 Table of Contents Feed for the Digital Edition of Muse Matters - Spring 2009 Muse Matters - Spring 2009 Muse Matters - Spring 2009 - (Page 1) Muse Matters - Spring 2009 - (Page 2) Muse Matters - Spring 2009 - (Page 3) Muse Matters - Spring 2009 - (Page 4) Muse Matters - Spring 2009 - (Page 5) Muse Matters - Spring 2009 - (Page 6) Muse Matters - Spring 2009 - (Page 7) Muse Matters - Spring 2009 - (Page 8) Muse Matters - Spring 2009 - (Page 9) Muse Matters - Spring 2009 - (Page 10) Muse Matters - Spring 2009 - (Page 11) Muse Matters - Spring 2009 - (Page 12) Muse Matters - Spring 2009 - (Page 13) Muse Matters - Spring 2009 - (Page 14) Muse Matters - Spring 2009 - (Page 15) Muse Matters - Spring 2009 - (Page 16) Muse Matters - Spring 2009 - (Page 17) Muse Matters - Spring 2009 - (Page 18) Muse Matters - Spring 2009 - (Page 19) Muse Matters - Spring 2009 - (Page 20) Muse Matters - Spring 2009 - (Page 21) Muse Matters - Spring 2009 - (Page 22) Muse Matters - Spring 2009 - (Page 23) Muse Matters - Spring 2009 - (Page 24) Muse Matters - Spring 2009 - (Page 25) Muse Matters - Spring 2009 - (Page 26) Muse Matters - Spring 2009 - (Page 27) Muse Matters - Spring 2009 - (Page 28) Muse Matters - Spring 2009 - (Page 29) Muse Matters - Spring 2009 - (Page 30) Muse Matters - Spring 2009 - (Page 31) Muse Matters - Spring 2009 - (Page 32) Muse Matters - Spring 2009 - (Page 33) Muse Matters - Spring 2009 - (Page 34) Muse Matters - Spring 2009 - (Page 35) Muse Matters - Spring 2009 - (Page 36) Muse Matters - Spring 2009 - (Page 37) Muse Matters - Spring 2009 - (Page 38) Muse Matters - Spring 2009 - (Page 39) Muse Matters - Spring 2009 - (Page 40) Muse Matters - Spring 2009 - (Page 41) Muse Matters - Spring 2009 - (Page 42) Muse Matters - Spring 2009 - (Page 43) Muse Matters - Spring 2009 - (Page 44) Muse Matters - Spring 2009 - (Page 45) Muse Matters - Spring 2009 - (Page 46) Muse Matters - Spring 2009 - (Page 47) Muse Matters - Spring 2009 - (Page 48) http://www.nxtbookMEDIA.com
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