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 Succeeding under recovery auditor contracts (RAC) is like raising a child--it takes a village. Or as in the case of RAC, it takes a team. To succeed under RAC, health care provider organizations need to prepare. And the first step in RAC preparedness is to develop a core team of experienced health care professionals at least 6 months prior to receiving the first RAC request.
The need for a well-functioning and dedicated RAC team isn't new. Anyone involved in the RAC pilot or gearing up for a 2009 roll-out understands it will be a monumental effort. In fact, a survey of HIM directors conducted in 2008 revealed that 57 percent had already created a special task force to examine documentation, coding and billing (See HIM Director Survey Sheds Light on RACs.) In this month's column, we explore the who, what and when of creating a RAC committee. And yes, HIM must be involved!
Team Roles and Responsibilities
Creating your RAC team is like designing the floor plan for a house. You need to work within your budget while looking ahead to accommodate future needs and growth. To adequately cover your RAC needs, you'll need to include the following "roles":
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Revenue integrity / compliance
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Health information management
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Information technology
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Finance
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Medical staff
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Case management
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Charge description master
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Business office
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Ancillary staff
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Nursing
 Beyond roles, there are several key qualities that team members must exhibit for success. Specifically, team members must be detail-oriented, analytical and possibly experienced with other types of external audits or reviews.
And finally, team members must assume some basic RAC responsibilities that line-up parallel to their organizational roles. For example, the information technology representative (typically the chief information officer, CIO) should take the lead in looking at improved systems to support RAC. This may include upgrading coding systems to maximize accuracy, ensuring the integrity of financial systems, upgrading case mix tools and implementing business intelligence software. And perhaps most importantly, the CIO can be instrumental in selecting or developing a RAC tracking application. According to Richard Grundling, a vice president at the Chicago-based Healthcare Financial Management Association, maintaining the records of the RAC review request and all the subsequent documentation and communication is the CIO's principal role.
RAC Teams: An Opportunity for HIM to Shine
For HIM professionals, RAC presents a new opportunity to elevate awareness about our profession, demonstrate our effectiveness and provide exemplary leadership within our organizations. RAC can be the next step in your career ladder and an excellent way to elevate awareness among the team. Specific HIM responsibilities within a RAC team include:
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Managing operational tasks involved with RAC; release of information, coding and documentation auditing, and financial outcomes tracking.
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Reviewing and approving records before they are sent to the RAC.
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Educating coders about specific RAC requirements and nuances, based on RAC findings.
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Educating physicians about RAC denials resulting from poor clinical documentation.
Latest RAC News
On Feb. 6, CMS announced that the bid protests submitted in late 2008 by two of the original RAC contractors, Viant, Inc. and PRG Schultz, USA, Inc. had been withdrawn. CMS plans to resume progress on the RAC program with implementation into the next group of states: Montana, Wyoming, Colorado, New Mexico, Arizona, North Dakota, South Dakota, Minnesota, Utah, Michigan, Indiana, New York, Vermont, New Hampshire, Maine, Massachusetts and Rhode Island. At this point, CMS has not formally announced whether the delay associated with the bid protests will impact the original implementation timeline. |
Best Practices for an Effective RAC Team
The RAC team must focus on implementing policies, procedures and technologies to help the organization successfully meet--and exceed--RAC requirements. But beyond immediate RAC needs, a successful team will extend their vision to include an overarching commitment to clinical documentation improvement (CDI) and coding/revenue integrity. RAC gives everyone involved the opportunity to heighten their understanding and dedication to CDI. As a result, the entire organization may witness broader improvements in case mix, revenue and coding.
Best practices suggest that the team hold dedicated RAC meetings on a monthly basis, beginning at least six months prior to RAC implementation for the state. And in that first meeting, education about RAC and learning from peers should be the focus. Once RAC requests begin to be received, weekly team meetings should be held for at least the first quarter of implementation and preferably, through the first 6 months of RAC. During this time, processes, procedures, resource requirements and performance will be continually evaluated and tweaked as necessary.
Following the first 60 days, a minimum of bi-monthly RAC meetings are suggested for the first year and monthly thereafter. A designated team leader will be needed along with action plans, status reports and a database reporting tool that is easily accessible by all team members.
As you work to create your RAC team--or simply get involved--look to this column for practical advice and tips. We're all in this together and learning from each other will be the key to everyone's success. Next month, we'll discuss the next step in RAC preparedness, evaluating and measuring your risk.
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.
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