Compliance 360 Claims Auditor™ for Medicare CMS RAC Audits (Recovery Audit Contractors)
According to Centers for Medicare and Medicaid Services (CMS) figures from 2007, estimated improper Medicare payments exceed $10 billion annually. In an effort to recover these lost funds and reduce future losses, CMS launched the Recovery Audit Contractor (RAC) program in a limited pilot in several states in 2005. Based on the success of the pilot program, with more than $1 billion in improper payments corrected, the RAC program is planned for a nationwide rollout to be fully implemented by 2010. The RAC program, compared to other Medicare and Medicaid claims audit programs, is unique, with RAC contractors paid a commission based on the revenues they recoup from healthcare providers.
Medical claims audits embody significant risk to revenues
and profit margins for any healthcare provider. These audits
typically include very complex appeals processes with stiff penalties
such as the automatic recoupment of funds if appeals deadlines are
not met. You need to be prepared with a system that can
help you manage the entire audit process from the initial request,
to demand letters, timely replies, determinations and appeals. You
also need the detailed information in hand to make well-informed
decisions on proceeding with appeals. When appeals are filed,
you need the ability to track all the critical dates and ensure that
input from each department is received and processed in a timely
manner.
The Compliance 360 Claims Auditor™ helps healthcare providers manage a wide variety of medical claims audits and appeals, including those conducted under the CMS Medicare Recovery Audit Contractor (RAC) program. The Claims Auditor is part of the industry leading Compliance 360 solution for healthcare that enables a comprehensive approach to regulatory compliance and risk management through one comprehensive, enterprise-wide platform.
With the Compliance 360 Claims Auditor for CMS Medicare
RAC Audits, you can:
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Establish your “Claims
Audit System of Record” by using the Compliance 360 Claims
Auditor as your central location for managing all claims audits
and storing all related information. |
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Manage the entire claims audit process
across all departments and create organizational accountability.
With highly configurable workflow and specific workflow templates
for RAC audits, non-technical personnel can efficiently automate
processes, activities, and due-date alerts across all departments
in their hospitals. |
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Make well-informed decisions throughout
complex claims audit and appeals processes and proceed with appeals
only when the outcome is likely to be successful. |
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Minimize the recoupment of funds by managing
the appeals windows to ensure that critical deadlines are not
missed. |
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Provide executive visibility with real-time
dashboards. Executives and other key decision makers can closely
monitor the status of pending appeals and the financial exposure
of active medical claims audits. |
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Proactively establish barriers to auditors
by demonstrating an “in control” status with efficient
self assessments and internal defense audits. |
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Incorporate claims audit management into
your broader compliance and risk management programs using the
comprehensive Compliance 360 GRC platform. This is important
for hospitals seeking to address the increasing governance and
risk management needs of their boards of directors in today’s
climate of increasing demands for regulatory oversight and scrutiny
of bonds rating agencies. |
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Accomplish all of these objectives without
installing or maintaining any software or additional computers.
The entire Compliance 360 system including the Claims Auditor
is provided as a secure Internet service that can be accessed
from any location. |
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Utilize complementary advisory consulting
services to assess vulnerabilities and implement process improvements
based on CMS guidelines. These services can also be used to assist
with the defense of RAC audits and preparation for appeals. |
The Compliance 360 Claims Auditor has been designed for managing
a wide variety of claims audits in addition to RAC, including Medicare
Program Safeguard Contractor (PSC) audits, Medicare Comprehensive
Error Rate Testing (CERT) audits, Medicaid Integrity Contractor (MIC)
audits and Medicaid Fraud Control Unit (MFCU) audits. With this one
comprehensive solution, hospitals can manage and reduce the financial
risks of all of their medical claims audits.
Compliance 360 Claims Auditor Demonstrations for CMS Medicare
RAC Audits
To request a Compliance 360 Claims Auditor demonstration, please click HERE.
To request a Compliance 360 Claims Auditor brochure or to learn how leading healthcare
providers are using Compliance 360 to minimize their medical claims audit exposure
and how you can do the same, Contact
Us today.
Free RAC Training (On-Demand Webinars)
You are also invited to replay our on-demand recorded training webinars on RAC. These training webinars have been attended by more than 1,000 participants and have received very positive feedback:
- “Preparing for a CMS RAC Audit: Minimize your RAC Losses. Maximize Your Quality of Care.” Click HERE to learn more and register to view the on-demand training.
- “RAC ATTACK: When to Appeal? How to Appeal? An Operational Guide to RAC Appeals” Click HERE to learn more and register to view the on-demand training.
Additional RAC Training Seminar Sponsored by Compliance 360, Inc.
Join the AR Systems faculty as we teach Consumerism in Patient Financial Services with the added bonus of AR Systems, Inc.'s RAC Attack classes. The pre-conference is offered for individuals/leaders who may be new to healthcare and are looking for a patient-financial services 101 class. The pre-conference is followed by 2 days of operational-focused education which will give you practical education and tools that you can immediately implement at your facility.
Remaining 2008 Locations and Dates:
Phoenix, AZ: Dec 14-16
Learn More
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