Organization key when the RAC requests arrive
Organization key when the RAC requests arrive
Develop a system to track requests, appeals
When the Recovery Audit Contractor (RAC) demonstration project began, the RACs began sending out chart requests slowly in the initial months, then increased the volume as the project went on, sometimes issuing requests for as many as 500 records at one time.
"The prospect of dealing with hundreds of records and five levels of appeals in a timely manner means hospitals must be extremely organized so they can respond quickly and must have some type of system to track everything that is requested and sent out," says Deborah Mallon, RN, MPA, CCS, assistant vice president, clinical documentation management, North Shore-Long Island Jewish Health System.
"Tracking is absolutely necessary. Otherwise, you may miss deadlines and lose your appeal. Hospitals need to maintain excellent records and record everything they send out. We scan every return receipt and every [piece of] overnight mail so we have proof that we have delivered the response in a timely manner," Mellon says.
"Hospitals have to keep track of what requests come in, how long they have to provide the records, and how long they have to appeal denials. If they do the paperwork in a timely manner, they will lose by default," adds Debra Brockmeyer, BSN, RN, CPUR, division director of case management for HCA Healthcare's Florida division.
Log in to your electronic system every individual request on a RAC communication and include every detail, advises Lori Dempsey, vice president of financial compliance for Lutheran Medical Center in New York City.
For instance, if the RAC requests relate to a specific CPT code, log each individual request.
"It takes a lot of work in the beginning, but if you don't log everything in the detail level, you won't be able to get the reporting you need on the back end," she says.
Input on front end
In the demonstration project, the RACs typically sent out automated overpayment letters that identified multiple lines of outpatient services on one correspondence, Dempsey says.
"At first glance, it looked like all the requests were for the same service/department, but it turned out that wasn't the case. It's tempting to log the request in by the number of cases and the CPT4 code, but when we analyzed the request in detail, we realized that the services were for multiple areas and departments. Had we not input the detail on the front end, we would not have been able to ascertain the details at the back, which would have masked our opportunities for improvement," she says.
Dempsey recommends logging in each individual record request with the following information: patient name, date of service, type of service, CPT code, and any other details provided by the RACs.
Scan or keep everything, including the envelope the record requests came in, suggests Delilah Dennis, RN, QIO liaison at Bay Medical Center in Panama City, FL.
The Florida RAC initially denied some appeals for Bay Medical, claiming that the hospital didn't comply with the time limit.
"We were able to prove that we met the deadline because we had copies of when we received the letter and when we sent the appeal," Dennis says.
Some hospitals in the demo project reported that the RACs sent requests for records to one person, letters of denials to another, and responses to appeals to another.
Sometimes, the information would stay in someone's inbox for several days, delaying the hospital's response, adds Dennis, who recommends designating one person to receive all the RAC mail.
At North-Shore Long Island Jewish Health System, all RAC requests for every hospital in the system will be sent to one post office box.
"This way, we have a handle on what is coming in so we don't lose our opportunity to appeal," Kreuder says.
During the demonstration program, the Health Information Management team at HCA Healthcare's East Florida division used the corporate database to maintain a spreadsheet that what requests for records were coming in and where they were in the appeals process.
"The case managers had access to the database so if we wrote appeals letters, we could document it," Brockmeyer says.
Now that the permanent RAC program is being rolled out, the hospital system has tweaked the database and added editing tools that include response times.
When the Recovery Audit Contractor (RAC) demonstration project began, the RACs began sending out chart requests slowly in the initial months, then increased the volume as the project went on, sometimes issuing requests for as many as 500 records at one time.Subscribe Now for Access
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