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RAC Audit Automation
Automation May Help with Your RAC Audit
With the nationwide roll-out of the Medicare Recovery Audit Contractor (RAC) Program in the next year, hospitals are looking for ways to minimize resources required for a RAC audit, avoid potential underpayment issues and ensure maximum allowable reimbursement from Medicare. Using automation software in several areas of claims processing may help reduce the problems associated with RAC audits.
Reducing Claims Denials
Before the RAC audit, Boston WorkStation is being used to scrub a spreadsheet of denied claims to accelerate resubmission and allow staff to focus on problem claims. Read more about this solution.
RAC Status Checking
Many providers wanted to closely monitor the status of their medical record submissions to the RACs. This required providers to place frequent phone calls to RACs and to read a list of case ID numbers to see whether the RAC had received the medical records. By 2010, the Centers for Medicaid and Medicare Services (CMS) will require all RACs to maintain a Web portal to display to each provider the status of all RAC medical record requests. Consider using task automation software, Boston WorkStation for your RAC audit, to login to the RAC site, check case numbers and distribute a report of its findings.
Automating some of the appeals process
Because providers appealed only 14% of RAC determinations during the testing period and only 4.6 % were overturned on appeal, CMS determined that providers would not appeal every RAC overpayment determination. Providers may believe that the effort and cost involved in filing an appeal outweigh the benefits of winning an appeal. Boston WorkStation may aid in accurately gathering required medical records, reading and creating the necessary forms for the RAC audit appeals process.
Resubmit claims when necessary services were provided in the wrong setting
During the initial RAC audits, CMS waived the “timely claim filing” limits and allowed hospitals to resubmit claims for outpatient ancillary services in these situations. Scripting software such as Boston WorkStation can be used to correct claims that have been improperly coded or modified, dated or did not meet simple medical necessity policies.
Contact us to discuss how Boston WorkStation can be used as part of your RAC Audit strategy.
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