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RAC Audit Tracking Solution

Posted: Mar. 4, 2009

The Basics

An auditor walks in the door tomorrow, are you ready? RAC audits have the potential to cost your organization millions of dollars. Not only do you have to worry about paying for overpayment determinations, conducting the audit in the first place can be outrageously expensive.

The Challenges

RAC Audits have already recouped $980 million in overpayments. Typical Medicare reimbursements from a healthcare organization ranged from $10,000 – $1.2 million. RAC auditors made 525,000 overpayment determinations during the demonstration program. Of 102,000 appeals, only 4.6 percent of the reviews were overturned. A single appeal can cost up to $30,000. Here are the challenges you will face:

  • Loss of revenue. Insufficient proof of medical necessity leads to overpayment determinations.
  • Strict timelines. You must provide the requested information and appeals before deadlines are up or overpayments will be assumed.
  • Finding the resources to manage the RAC audit process. Manually searching for documents is time consuming and expensive.

The Solution

You can’t afford to be unprepared. OnBase document management is your tool against both costly aspects of the RAC program. The audit process is easier for you and you have the information to prevent overpayment determinations. Prepare yourself with document management.

We did our homework. We took the time to develop a solution based on our customers’ real life experiences. We reached out to our strong base of OnBase customers in regions that participated in the initial demonstration of the RAC program. We walked in their shoes to uncover the issues surrounding the audit process.

Working with them, we designed a solution that addresses the toughest parts of a RAC audit so when an auditor walks in the door, you’re ready.

Meet Deadlines without Adding Staff

The OnBase RAC Solution manages the audit process from start to finish so you never miss a deadline or have to hire more people.

Instead of manually pulling documents and tracking progress on a spreadsheet, you manage the entire audit – documents and progress – in an easy-to-view dashboard. You don’t search through piles of paper or track requests individually. You complete the audit on time and without more people.

Once an auditor’s request is received, OnBase auto-calculates requests and tracks the steps to be completed, who it’s assigned to, expected completion date, appeal dates and more. A dashboard view of all requests clearly shows the time remaining to complete the next step.

  • Automatic e-mail notifications keep process moving and remove hold-ups
  • Management views provide average processing times that drill down by specific criteria to identify and correct bottlenecks
  • Preserves historical activity of entire audit so you can determine trends and weaknesses in RAC response

All the Information to Prove Your Case

RAC auditors find overpayments when there is a lack of proof of medical necessity. Without the right information (lab results, clinical information, progress notes, etc.), you don’t have the proof to prevent overpayment determinations. OnBase enables you to store all of this information in a central repository – no more worrying about missing documents.

By scanning in paper and importing data from disconnected systems, you go to a single repository when an auditor comes in. You have all the information to justify all of the payments you deserve all in one place. During an appeal, the more information you have, the greater your chances of winning.

The Payoff

  • Prevent lost revenue due to overpayment findings
  • Respond to RAC auditors’ requests within timelines
  • Eliminate need to hire staff to manage audits; minimize audit expenses

Learn More

For more information on the OnBase RAC Audit Tracking Solution, please contact Naviant at 888.686.4624 or solutions@naviant-inc.com.

You may also find more information in the OnBase RAC Audit Tracking Solution Brochure found below.