RAC Audits - Are You Ready?

Recovery Audit Contractor, or more commonly known as RAC audits, is an effort of the Centers for Medicare & Medicaid Services (CMS) to minimize overpayments to providers. The RAC program was implemented to protect the Medicare Trust Fund from fraud, abuse, and waste. In 2007, $10.8 billion dollars were identified as improper payments. Healthcare providers who bill Medicare, including home healthcare organizations, will be subject to audits by contractors who have been selected by CMS. These contractors are paid on contingency based on the amount of improper payments they find and collect.

While the home healthcare industry is watching and waiting for RAC audits to occur, here are some tips on how to help prepare your agency and staff.

RAC Force to the Rescue:

• Form a task force within your agency. Develop a team that includes a variety of staff including, managers, supervisors and clinicians. Charge them with the task of gathering information about RACs and encourage them to become your in-house RAC experts.

Knowledge is Key:

• Educate your staff on expectations of RAC and provide them with the skills to help them prepare. Offer trainings or a tip sheet on how clinicians can improve documentation. Set-up regular chart reviews and use the reviews as a teachable moment to improve overall agency documentation.

At the Root of it all - Documentation:

• Improve agency documentation. Ensure clinical records are in compliance with the audits. Does the 485 match the plan of care that staff is following in the record? Does the frequency of orders match the frequency of the visits?

It may be another year or more before the first contractor will request a home care-related claims issue. But when they do come knocking they'll be looking back as far as three years, so it is important that the assessments and charts your clinicians are doing today are in compliance.

A RAC Audit tool was created, by NAHC list serve members, as way to quickly audit charts, both clinically and financially, to see if any red flags were raised. Download the tool here.

Does your current technology platform guide clinicians through the documentation process helping to ensure accuracy and compliance? By implementing an appropriate strategic technology platform you will not only survive RAC audits but soar through them. To learn more about how a clinical and billing technology system can improve your compliance and dramatically assist your agency in creating success today and in the future. Call 717.283.0980 or email learnmore@thornberryltd.com