The adjustment to recovery audit contractors (RACs) has been a trying one for HIM departments and vendors alike.

"During the demonstration period, a number of our sites started sending us the RAC requests for records," recalled Lori Brocato, manager of revenue cycle technology for HealthPort, located in Atlanta. "Because of the sheer number of requests we were receiving from some clients, we really had to gear up our staff."

Meanwhile, at the American Hospital Association (AHA), Elizabeth Baskett was starting her new position as the AHA's associate director for policy. Among her duties would be handling the new RACTrac program, a Web-based survey for hospitals to report on their RAC experience.

"The [RACTrac] concept began during the demonstration period," explained Baskett. "We found there was a lack of data on the impact of the program on our members. That's where the idea was born."

The survey hopes to determine what's happening with RACs in the participating facilities, what specific RAC-related activities are taking place, and the impact of those activities from both a financial and administrative perspective.

Introduction to RACTrac

Based on working with sites during the demonstration period, Brocato saw the need for record tracking throughout the entire RAC process. They were able to track the records as they went out the door and receive confirmation once those records were received by the RAC-but beyond that point, they were unable to track the process.

"We didn't know if we needed to follow up-and if a follow-up was needed, we wouldn't know when to do so," explained Brocato. "We also wanted the ability to do some statistical analysis to find out what is being reviewed on a consistent basis and help to put processes in place to fix those problems."

One client went as far as to put together a spreadsheet that demonstrated their need for real-time alerts. "They were missing deadlines and getting technical denials," said Brocato, "and they asked us to improve on the situation. That's where our RACPro application originated."

At CPR Technologies in Los Angeles, Cathy Malin, RHIT, was facing similar challenges. Her company's goal was to provide its clients with an inexpensive tracking tool that was not only RACTrac-compatible, but could also record other audits from inception to the date of completion.

"Our clients were telling us that Excel alone was not working for them," said Malin, a client support specialist with CPR.

They created Plato RAC Track, which can track, trend and analyze the progress of audits while emphasizing the bottom line for future improvements.

Moreover, they were able to project potential recoupment to minimize the likelihood of future RAC requests.

"2010 starts a stressful time for health care providers," explained Malin, "and as one of the few approved vendors for the AHA, Plato RAC Track has been held to strict reporting guidelines."

On the AHA side, RACTrac was ready to go earlier in 2009-but the launch was delayed due to a lack of activity on the part of RACs. For the purposes of the program, the country was divided into four distinct regions-labeled Regions A-D for easy identification-and only Region C (consisting of much of the South, particularly Alabama, Georgia, Florida and the Carolinas) was seeing consistent or widespread RAC activity. Therefore, the program is being launched this month.

"We'll be inviting all facilities that have experienced RAC activity in the last quarter of 2009 to report all their data to RACTrac," explained Baskett.

Due to the lack of widespread RAC activity, the initial launch is described as a "rollout," a smaller-scale introduction to the process that will utilize information from only the already-impacted facilities in the aforementioned region. Baskett clarified that AHA fully expects widespread activity in all four regions of the country early in 2010, meaning that RACTrac can be introduced nationwide by the second quarter of this year.

Program Impact

For many sites, medical necessity and patient status issues were most prevalent and were most commonly mentioned as the concerns they hoped would be addressed. Much of this could be attributed to poor documentation, an issue solved by the inception of clinical documentation improvement programs at the affected facilities. People also mentioned coding issues, such as training and interpretation, but these complaints were few and far between compared to the medical necessity and patient status queries.

At HealthPort, the RACPro application takes the data fields required by RACTrac, formats them appropriately and allows AHA to upload the information for summary-level reporting. The AHA hopes to use the information received for advocacy purposes and identifying trends within the RAC program on both legislative and regulatory levels.

Within the next few weeks, each region's respective RAC figures to complete the necessary administrative work to perform audits, followed by issuing demand letters to each facility. Significant activity will begin shortly thereafter, at which time Baskett and the AHA can get the RACTrac program out of the starting blocks.

"In the second quarter of this year, AHA will be sending correspondence to the CEOs and executives of our member hospitals, informing them that RACTrac has gone nationwide," said Baskett.

Response

On the vendor side, the response has been rather prevalent. In competitive situations, many sites require compatibility with RACTrac. Even those hospitals and facilities that were largely unfamiliar with RACTrac seemed to prefer systems that were compatible when given the choice.

This is all great news for the AHA, as Baskett admitted that successful implementation of the program will require a significant rate of participation for advocacy purposes. She stopped short, however, of setting an actual target.

"There has been nationwide interest, which is encouraging," she concluded. "I can't set a specific target for participation-just as many people as possible!"

• For more information on AHA's RACTrac program, visit www.aha.org/aha/issues/RAC/index.html.

Rob Senior is a managing editor at ADVANCE.