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RACs Moving Forward: Year of Uncertainty is Over

RACs are back! Following several delays and multiple lawsuits, the Centers for Medicare and Medicaid Services (CMS) has finally awarded the new RAC contracts. After a standstill in 2016, as RAC regions remained unresolved, RACs now have the green light to fully reengage and return to business as usual.

In the May 2017 issue of HCPro’s HIM Briefings, I covered the topic of the return of RACs and outlined what Health Information Management (HIM) professionals can do to prepare for the next round of audits, including four tips to stay proactive and avoid becoming overwhelmed.

Four Tips for HIM Pros on Dealing with RACs

  1. Review and refine processes – Implement effective processes to maximize reimbursement and minimize takebacks. Conduct internal reviews and audits, review all clinical documentation, and continually refine workflow processes for these cases.
  2. Document and track – HIM’s most important role is to document and track every step of RAC reviews for every case. Use spreadsheets or an IT application, such as MRO’s AUDITRENDS® Online, in conjunction with a vendor partner.
  3. Increase collaboration – Effective RAC risk mitigation extends beyond your designated RAC team. Increase communication and collaboration among RAC teams, coders and CDI specialists. All should work together to reduce RAC risk.
  4. Continually develop staff – Team members must also become RAC experts. This includes education and training on how to deal with everchanging program parameters, meet tightening deadlines, and manage a deluge of auditor requests. RAC specialists must determine which audit data is most important and be able to uncover data integrity issues in collaboration with the audit and coding teams.

To learn about MRO’s payer audit management solutions, visit the MRO website or visit us at the HFMA ANI convention June 25-28, 2017 in Orlando, Florida – Booth #1150.

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