RAC Audits: The Calm Before the Storm

RAC Audits Excelas Medical Legal Solutions

The Center for Medicare and Medicaid Services (CMS) recently announced that healthcare providers would begin to see a decline in the number of additional documentation requests (ADRs) they receive, beginning in June 2013. Operating under the current program, which allows up to 400 requests per provider, per each 45-day period, this is welcome news.

The not-so-welcome news? The relief will only be temporary. CMS has begun the process of selecting and transitioning to the next round of recovery audit contractor (RAC) contracts, and they’re attempting to reduce the number of open claims that will overlap with the new contracts. CMS also notes that pre-payment reviews and post-payment manual therapy reviews will continue at present levels. But, some relief is better than no relief.

Once the new contract period begins (sometime in 2014), a fifth contractor will be included in the program. There will still be four A/B RACs, just as there are now—though whether any of the current auditors receive new contracts remains to be seen. The new, fifth contractor will focus exclusively on home health, hospice, and durable medical equipment (DME) claims.

Ultimately, there is one implication and one opportunity to be found in this announcement. First, the implication is that once the new contract period begins, healthcare providers will feel a greater burden from the RACs. CMS will have more horsepower under its hood, which means there may be a greater number of ADRs and, potentially, a greater number of focus areas being examined, with home health, hospice, and DME being obvious, but probably not exclusive.

But secondly, there’s inherent opportunity for healthcare providers in this CMS announcement: With a (somewhat) lighter burden beginning this spring, providers have the chance to get ahead of things. It’s common knowledge that documentation in the medical record is what will make or break an audit—any audit. Now is a great time to for healthcare providers to do internal audits on their own. This will allow providers to assess how staff is doing in regard to documentation practices and determine whether necessary documentation is happening at the appropriate times. This is what the RACs will be examining when they do a complex review of a healthcare facility’s resident records. There’s no better time than now for providers to find out where they are excelling, or where they need to implement facility-wide improvements.

To find out how we can help you ensure that your documentation will stand up to RAC scrutiny, talk to an expert at Excelas.

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