February 2009 Newsletter
RAC Audit Readiness with ECM
With the Tax Relief and Health Care Act of 2006, the Medicare Recovery Audit Contractor (RAC) program is projected to be fully commissioned by 2010. To the provider community, the commissioning of the program is raising many concerns in audit readiness. These concerns have manifested themselves through the following:
Documentation required for RAC audits
In the unfortunate event that an appointed RAC initiates an audit, the provider will be required to respond with the provisioning of Medical Records. Depending on the capability of the appointed RAC, the provisioned Medical Records can be submitted in either a hardcopy or an electronic (i.e. image) manner. In most cases, request for Medical Records will not encompass Claims or Remits, as the commissioned RACs have access to the said items through the CMS National Claims History repository.
Timelines governing RAC audits
A provider will have 45 calendar days to respond to a RAC’s request for Medical Records. In responding to the RAC’s request, the provider can either provision the Medical Records or request an extension. In requesting an extension, the provider must formally reach out to the appointed RAC within the 45 calendar-day window.
Administrative costs associated with RAC audits
Many variables come into play in assessing the administrative costs associated with RAC audits. How prone is the provider’s practice/medical discipline to RAC scrutiny? Can provisioned Medical Records be efficiently gathered for submission to the requesting RAC? Unfortunately, with the said variables, there is no true way to forecast provider administrative costs.
So where does this leave the provider community in regards to RAC audit readiness? Apart from the obvious effort of avoiding RAC scrutiny by billing in accordance with CMS’s guidelines, providers should prepare themselves to react to RAC requests in an efficient and timely manner. One such way to prepare is to maximize any Electronic Medical Record (EMR) or Enterprise Content Management (ECM) systems available for use. Both EMR and ECM solutions adequately enable providers to efficiently respond to RAC requests for Medical Records, thus reducing the administrative burden associated with hardcopy retrieval, copying, and re-filing. The said solutions also reduce the element of missing Medical Records, therefore equipping the provider with a chance to defend RAC audits.
For those in the provider community who have not adopted an EMR or ECM solution and have interest, you will be happy to learn that Quadax has service offerings in this area. Quadax’s ECM Services’ team specializes in the deployment of ECM solutions, offering the solutions in either an affordable SaaS or premise-installed business model.
For service inquires, please reach out to Phil Conard, VP of ECM Services, at 440-788-2176 or philconard@quadax.com.