There are times with no news is good news. Conversely, there are times when personal survival depends on up-to-the-minute, late-breaking information. For much of 2009, health care providers have found themselves assuming the former with regard to recovery audit contractors (RAC) -- no news has been good news. 

All that is changing as the permanent program has finally made some headway with automated reviews started in all four regions. This month's column takes a "time out" from appeals management to provide you with the latest news and information about the RAC roll-out. Perhaps it's finally time to tune-in and catch up on the news!

Latest Update: RAC Roll-Out
As mentioned above, automated audits are underway for all four regions with a focus on outpatient hospital, physician and durable medical equipment claims. Unfortunately, there is not much HIM directors can do to counter these audits, as they are primarily uncontestable and based purely on billing information. However, additional information can be found for each region at the following sites:

RAC Region A: http://www.dcsrac.com/portal.html

RAC Region B: http://racb.cgi.com/

RAC Region C: http://www.connollyhealthcare.com/RAC

RAC Region D: https://racinfo.healthdatainsights.com/

Complex reviews are another story -- and another source of no news is good news from Medicare. A recent American Hospital Association (AHA) RAC Report cites that complex audits have been delayed until November 2009 at the earliest and more probably will begin in 2010.

Organizations must stay tuned-in for all information about complex reviews as these audits warrant the most concern, carry the most risk for revenue take-backs and require the most resources to manage. HealthPort will continue to provide news updates on our RAC news and updates web page.  

Nancy Hirschl, CCS	Lori Brocato

Some News is GREAT News!
Also in the Oct. 9, 2009, RAC Report from AHA, it was noted that medical record request limits are changing. This is good news for organizations with more than one national provider identifier (NPI), as limits will now be set based on organizational tax identification numbers.

During the demonstration project, RACs were able to request up to 200 records every 45 days per NPI. While the new limit has not yet been set, the Centers for Medicare and Medicaid Services (CMS) informed AHA that limits will be based on tax ID, not NPI. Again, let's stay tuned to see what unfolds and how complex review record requests will impact workload in HIM and more specifically, release of information (ROI).

Other News Keeps You Covered
To help keep everyone better aware and measure impact on individual hospitals, the AHA further expanded their RACTrac program. Planned for launch in January 2010, the Web-based survey tool will provide ongoing monitoring to ensure RAC adherence to Medicare policy and assess RAC implications as they are occurring nationwide. The initial launch of RACTrac will focus on states with significant activity by the end of 2009.

Also new to the RACTrac program is the announcement of six technology providers with RACTrac Compatible solutions. These vendors have created upload software to quickly and easily summarize data for upload into RACTrac, thereby helping to promote the reporting and sharing of RAC information among providers. HealthPort's RACPro is included in this list; to see a full list of compatible vendors, visit: http://www.aha.org/aha/content/2009/pdf/09ractracvendors.pdf

Stay Tuned
Finally, the most important news of 2009 may not even involve RAC! Other payers have started revenue recovery demonstration programs, and more are being planned. For example, Medicaid Integrity Contractors (MICs) are underway in many areas across the nation with a similar purpose as the RAC, but reported to be even more aggressive and demanding for HIM.  More news will be released on MICs later this month, but look for evaluation and management (E/M) codes to be on their radar screen.

As with many other Medicare programs, third-party payers are realizing that recovery audits may be a new place to recoup funds and identify overpayments to providers. Just what we needed, more audits!

Read more next month on how to cost-justify the appeals process and determine when a lengthy appeal makes sense for you, your physicians and your organization's bottom line.

Lori Brocato is currently the revenue cycle management product manager for HealthPort. Nancy Hirschl is president and CEO of Hirschl and Associates, Laguna Niguel, CA.