RAC Solution Critical Success Factors

RAC Audits embody significant risk to legitimate 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 missed, even by as little as one day. You need to be prepared with a system that can help you manage the entire RAC Audit process from the initial record request, to 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.

As we’ve worked with several dozen hospitals preparing for RAC Audits during the 100-day delay, we’ve encountered challenges and requirements that are very consistent from one organization to the next. From this, we’ve identified the requirements that we believe are critical to achieving success with any RAC Audit solution. Click here to read what we've learned during the 100-day delay.

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:

• Minimize the risk of losing your legitimate revenues by integrating RAC Audits into your “Claims Audit System of Record”. Use the Compliance 360 Claims Auditor as your central location for managing all claims audits and storing all related information.

• Manage the entire RAC Audit process across all departments and create organizational accountability. With highly configurable workflow and specific workflow templates for Automated and Complex RAC Audits, compliance professionals can efficiently automate processes, activities, and due-date alerts across all departments in your hospital.

• Make well-informed decisions throughout complex RAC Audit and appeals processes and proceed with appeals only when the outcome is likely to be successful.

• Minimize the automatic recoupment of funds by managing the RAC Audit appeals windows to ensure that critical deadlines are not missed.

• Provide executive visibility with real-time dashboards. Executives and other key decision makers can closely monitor the status of pending RAC Audit appeals and any other claims audit appeals to gauge the financial exposure of active medical claims audits.

• Proactively establish barriers to RAC Auditors by demonstrating an “in control” status with efficient self assessments and internal defense audits.

• Incorporate RAC Audit management into your broader compliance and risk management programs using the comprehensive Compliance 360 GRC platform. This is important for hospitals and healthcare systems seeking to address the increasing governance and risk management needs of their boards of directors and investors in today’s climate of increasing regulatory scrutiny and demands for oversight.

• 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.

• 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.

Demonstrations of the Compliance 360 Claims Auditor for CMS Medicare RAC Audits

To learn more about using the Compliance 360 Claims Auditor to manage your RAC Audits and appeals we invite you to view a recorded demonstration of the system:

• Claims Auditor Demo: Your Best Defense for RAC Audits
  On-demand web demo. Click Here to request access to the recording.

Free RAC Audit 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.