Healthcare - CMS Medicare RAC Audits

RAC Solution Critical Success Factors

RAC audits embody significant risk to legitimate revenues and profit margins for healthcare providers. 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 TAKE CONTROL of 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 been working with hundreds of hospitals managing RAC audits, 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 Claims Audit solution. Click here to read what we've learned.

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:

• Take control of the RAC audit process to minimize the risk of losing your legitimate revenues.

• Automate the management of the entire RAC audit process across all departments and create organizational accountability with highly configurable workflow.  With automated workflow and specific workflow templates for Automated and Complex RAC audits, the Claims Auditor functions as your “Virtual RAC Audit Coordinator”, enforcing deadlines and due dates throughout your organization and providing alerts that enable you team to avoid the automatic recoupment of legitimate revenues.

• Integrate RAC audits into your “Claims Audit System of Record”. Use the Compliance 360 Claims Auditor as your central location for managing RAC audits and all medical claims audits including MIC, MAC, CERT, PERM, MFCU, ZPIC and others.  With the Compliance 360 Claims Auditor, there is NO ADDITIONAL Cost, as you expand the use to incorporate all claims audits.  There is no need to purchase or install additional software.  The expansion is accomplished using configurable workflow capabilities and audit-specific workflow templates provided by Compliance 360.

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

• 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:

• Compliance 360 Claims Auditor: Take Control of RAC Audits
  On-demand web demo

Free RAC Audit Training (Live and On-Demand Webinars)

You are also invited to attend our live broadcasts or replay our on-demand recorded training webinars at your convenience. These training webinars have been attended by more than 10,000 participants and have received very positive feedback.  Click Here for the full list of live and on-demand training webinars.

Learn More

To learn how leading healthcare providers are using Compliance 360 to minimize their compliance overhead and risks, and how you can be do the same, contact us today.