Everyone is concerned about the Recovery Audit Contractors (RAC) and what impact they will have on their practices. To find the RAC for your area click on the following link:
There are some things that we do know right now regarding RAC:
Targeted areas will be based on two factors:
The results of the RAC Demonstration Project
Comprehensive Error Rate Testing Program (CERT)
Results from the demonstration project indicate that most of the retrieved revenue came from the inpatient setting (85%). Make sure your physicians are documenting efficiently and signing test orders, drug orders, etc.
Support the inpatient consults with appropriate documentation:
Documentation of the request for an opinion from a qualified individual
Documentation that the referring physician will be collaborating on the case.
Make sure your physicians are documenting a chief complaint on all subsequent hospital care visits (follow up hospital visit 99231-99233). This is an easy one for RAC’s since many physicians never document a chief complaint in the hospital.
RAC’s WILL be looking at E&M visits. Make sure that your physicians BONE UP on their documentation techniques and are coding correctly.
Look at the most recent CERT report: https://www.cms.hhs.gov/apps/er_report/preview_er_report.asp?from=public&which=long&reportID=9&tab=4
Look for the areas that have a high error rate. See if you are efficient in that area. That will likely be where the RAC’s will look.
Those who are proactive regarding RAC’s will be the practices that are prepared in the event that a RAC comes calling.
