Case Studies: RAC Audit
When CMS announced its plans for the three-year Recovery Audit Contractor (RAC) demonstration project, hospitals in the targeted states of California, Florida and New York braced for the anticipated high volume of extra work the initiative would produce.
One West coast health system tackled the challenge of increased workloads by partnering with Precyse Solutions. More than just an extra pair of hands, the health system selected Precyse for its extensive health information management, coding and com- pliance knowledge base and its ability to develop and deliver effective education programs to analyze and respond to the barrage of government requests.
Precyse’s record reviews of initially-billed DRGs questioned by the RAC have helped the health system identify coding errors relative to specific DRGs. Precyse has also identified instances where the RAC determination was incorrect and, in these situations, Precyse has helped the organization compose appropriate dispute letters. Throughout this process, the health system has successfully overturned a number of RAC decisions and has identified opportunities for focused coder educa- tion and coaching in physician documentation.
The Corporate Director of HIM attributes a number of operational improvements to Precyse’s involvement with the team, “We interact with Precyse consultants on a true partnership basis. Improving processes, education and work product is foremost on everyone’s mind. We asked that Precyse custom build, from scratch, the educational programs we needed. The Precyse consultants working with us are sharp and quick. The RAC reports produced by the consultants provide the trend data we need to drill down to individual DRGs and codes.”
To date, Precyse has developed and delivered five custom education sessions for the health system. Another three are planned. Using the client’s WebEx platform, coders from all of the system’s multistate hospitals are able to participate. Anyone who missed the live presentation can listen to the recorded archived version. Precyse is able to measure knowledge retention through pre- and post- education testing.
Value of partnering with Precyse for RAC reviews:
- Identification of coding deficiencies
- Expert second opinion on RAC determinations
- Dispute letter drafting to support rebuttal
- System-wide Coder education and auditing programs to improve skills and compliance, physician documentation improvement initiatives, optimize data quality and appro- priate payment, and reduce future reviews.