RAC Preparation List
1. Develop a RAC task committee
Identify committee members roles and responsibilities
2. Identify RAC hub
Who will manage the program through each of the 6+ levels
How will the program be administered
Deployment
Workflow Management
Medical Records Requests
Appeal Process
Database Management
What will the tool be
What are the data sets
Who owns and manages it
3. Create communication plan
Who needs to know
What is the message, method and frequency of messaging
4. Perform a complete risk assessment
Audit Clinical Documentation for the high risk areas
Review Charge Description Master for correct coding and charge capture
Evaluate Charge Capture processes and procedures in high volume / high risk outpatient areas
Perform Systems Analysis
Order entry
Clinical
Financial
Review of all claims editing tools (front-end and back-end)
Audit policies for:
One Day Stays
Observation Patients
Transfer DRGs
Discharge Status
Re-examine your physician education programs and communication methods With proper program management, the burdensome process can be managed effectively
5. Infrastructure to manage the medical records requests
Determine if records will be stored on paper or electronically
Assess copy charges
6. Capability to manage every aspect of the program
Who owns each area
How to ensure that deadlines are not missed
7. Determine the appeal thresholds
Dollar Value
Type of claim / service provided
8. Track the data
What is requested and when
What is determined to be: OK, Overpaid, Underpaid
What is the level of appeal
Track reason for audits and results by reason, claim type, dollar amount, date of service, service area, etc…
9. Report to your local and national organizations
10. Use reported risks to implement preventative measures going forward
