The Recovery Audit Contractor (RAC) Program was authorized by Congress to identify improper Medicare payments (overpayments and underpayments). The Centers for Medicare & Medicaid Services (CMS) named four permanent Medicare Recovery Audit Contractors (RACs) as part of the nationwide program rollout. These contractors identify improper Medicare payments and receive a contingency fee based on a percentage of the improper payments they identify and collect.
The permanent RAC program allows claims to be audited for the following provider types: hospital inpatient and outpatient, long-term care hospitals, inpatient rehabilitation and psychiatric hospitals, critical access hospitals, skilled nursing facilities, physician, ambulance, laboratory, home health, hospice and durable medical equipment. Recovery Audit Contractors can review claims back to October 1, 2007.
This program requires a facility to assign scarce resources to critical tasks required to analyze and respond to RAC requests and develop tracking and appeal processes to protect revenues. SOURCECORP HealthSERVE assembled a team of internal and external experts to develop a suite of services to help our clients manage through the process and develop both business and legal appeal strategies.
The result was SOURCECORP RACSource, a financial management and appeals analysis tool. This state-of-the-art ASP offering was developed leveraging SOURCECORP’s extensive experience in denial management, coding and compliance auditing.Its efficient workflow, extensive and customizable reporting, and real time dashboards provide unprecedented efficiency in dealing with this critical process. More than a tracking tool, SOURCECORP RACSource is a comprehensive software and analytic solution providing real-time, ongoing prompts, reminders and alerts that ensure timelines and deadlines are always adhered to and never missed. More importantly, RACSource provides detailed client-specific analysis of the ongoing vulnerabilities of your site to RAC denials, and it identifies the documentation and process solutions that should be implemented to eliminate the weakness and prevent the denial months before the RAC identifies it.
SOURCECORP HealthSERVE provides the following RAP services:
Coding Audit / Risk Assessment
SOURCECORP HealthSERVE credentialed coding auditors will perform a full risk assessment comparing your actual data against known RAC target records. We will assist you in identifying and correcting improper Medicare payments due to coding, documentation and medical necessity issues. We conduct focused reviews of those high risk areas historically targeted in RAC audits and provide you with the information you need to be prepared and to formulate corrective action measures. Our audits can include a review of all record types in both the hospital-based and physician-based settings from acute med/surg facilities and physician practices to non-acute care settings including rehabilitation, behavioral health, long-term care and skilled nursing facilities.
We can also assist with the medical record review of RAC denials and RAC appeal preparation.
Medical Necessity
Successful management of RAC denials, or any other payer for that matter, is not based in an "after the care" retrospective defense. The solution that drives success is to learn through the application of RACSource analytics and make concurrent changes to the admission and registration processes. The true solution to effective denial management is preemptive and concurrent, before and during the patient's admission and treatment. We help to reduce your vulnerability by putting best practices and processes in place to catch errors before patient discharge and claims are submitted.
Education
Because thorough documentation is needed to support accurate coding, SOURCECORP HealthSERVE provides training and education programs, which include educating physicians in the process of documentation improvement efforts.
Financial Impact Analysis
SOURCECORP HealthSERVE’s RAP Program provides in-depth analysis and modeling to enable our clients to determine their current risk before and during a RAC audit. This critical information is a necessity for budget planning and RAC impact analysis.
Denial Management
SOURCECORP HealthSERVE will complete a hospital-specific analysis of your Medicare under/over payment status. This report, based on our initial analysis of your hospital’s current performance, will help you gauge where you stand on the current compliance scale. Our concurrent and retrospective focus on underpayments in conjunction with our RAC defense analysis provides our clients with the best opportunity to reduce the financial impact of RAC denials.
Data Aggregation
The RACSource tool allows analysis on RAC related information across all facilities in a hospital system.