News: 2010 RAC Preparedness Benchmarking Report released
December 23, 2010
CDI Strategies - Volume 4, Issue 26
The RAC program was fully under way in 2010, and providers continue to struggle with it as the year draws to a close. This year’s RAC Preparedness Benchmarking survey had 459 respondents representing hospitals of all sizes from all four RAC regions. Region C was the most responsive region, with almost twice the respondents as either Region A or D, although all were fairly well represented.
One of the most surprising findings was the number of providers who have not yet had a RAC request for a record. More than 50% of respondents had not had recoupments related to the automated audits and almost 40% had not even received a record request for a complex audit.
For those who had RAC interactions, the two most common problems reported were not receiving records requests in a timely fashion (17%) and not being able to identify RAC-related recoupments back to the individual claims being adjusted (18%).
Particularly troubling were a number of reported problems with the audits themselves. Providers reported receiving requests for records that were inappropriate for their payment system (e.g., DRG requests for non-IPPS hospitals), for records excluded from or ineligible for review (e.g., already reviewed by a claims contractor), and for issues that had not yet been approved or for DRGs not on the approved list. Providers also reported receiving requests more frequently than 45 days and that they exceeded the records request limitations.
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