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“10 Critical Actions to Minimize RAC Recoupment”

“10 Critical Actions to Minimize RAC Recoupment”. National Medicare RAC Summit Washington, DC March 6, 2009. Presenters. Stephen Forney, MBA, CPA, FACHE, FHFMA VP - Margin Development Ardent Health Services Nashville, TN 615-296-3054 stephen.forney@ ardenthealth.com.

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“10 Critical Actions to Minimize RAC Recoupment”

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  1. “10 Critical Actions to Minimize RAC Recoupment” National Medicare RAC Summit Washington, DC March 6, 2009

  2. Presenters Stephen Forney, MBA, CPA, FACHE, FHFMAVP - Margin DevelopmentArdent Health Services Nashville, TN 615-296-3054 stephen.forney@ ardenthealth.com Bill Phillips, FACMC, CHCAssociate Professor Health Svcs Mgt & Ldrshp Geo Washington Univ. / VP & Chief Revenue Off Revenue Strategies 786-371-6493 billinfll@juno.com (c) 2009 Revenue Strategies

  3. Outline A. How to Minimize RAC Recoupment • RAC - Newest ATM • Take Home… (c) 2009 Revenue Strategies

  4. A. How to Minimize Recoupment (c) 2009 Revenue Strategies

  5. 10 Critical Actions • RAC is not FI • Appoint Chief RAC Officer • Prepare, prepare, prepare (7 steps) • Conduct pre-RAC Audits • Implement RAC Record Request Tracking (c) 2009 Revenue Strategies

  6. 10 Critical Actions • Establish clinical & coding feedback • Calculate impact of overpayments • Start Yesterday • Appeal, appeal, appeal • Re-bill all IP denials as OP (c) 2009 Revenue Strategies

  7. # 3. Prepare, Prepare, Prepare Seven Steps • Identify all cases at risk • Prioritize by recoupment impact • Perform coding & medical necessity reviews • Establish RAC repository • Test RAC work flow • Prepare Recoupment Reports • Apply RAC up-dates (new targets, etc.) (c) 2009 Revenue Strategies

  8. # 4. Conduct pre-RAC audits (c) 2009 Revenue Strategies

  9. B. RAC – Newest ATM (c) 2009 Revenue Strategies

  10. RAC Recoupment ATM # 1: Automated • Electronic claim review • Duplicate claims • Same patient • Same date of service • Duplicate payment • RAC withdrawal ATM # 2: Complex • Manual review • Suspected error • Medical record needed • 45 days to reply • Site of service issue • Proper documentation • 1/3 are overpayments (c) 2009 Revenue Strategies

  11. Automated vs. Complex (c) 2009 Revenue Strategies

  12. C. Take Home (c) 2009 Revenue Strategies

  13. # 1: RAC – aka “Margin Eraser” RAC (c) 2009 Revenue Strategies

  14. 2009 Margin (c) 2009 Revenue Strategies

  15. Unprepared - 2010 Margin (c) 2009 Revenue Strategies

  16. Prepared - 2010 Margin (c) 2009 Revenue Strategies

  17. # 2: Start yesterday… • Review - Oct 1, 2007 – Apr 1, 2011 • Reviewable Now – Oct 1, 2007 – Mar 6, 2009 • 18 months • Reviewable Later – Mar 6, 2009 – Apr 1, 2011 • 24 months or more… (c) 2009 Revenue Strategies

  18. # 3: Prepare, Prepare, Prepare (c) 2009 Revenue Strategies

  19. # 4: Appeal, Appeal, Appeal (c) 2009 Revenue Strategies

  20. If not… RAC (c) 2009 Revenue Strategies

  21. References • “RAC Demo Report”, CMS, Mar 2008 • “RAC Demo – Update”, CMS, Sep 2008 • “10 Critical Actions to Minimize RAC Recoupment”, Forney & Phillips, HLF, 2009 • “RAC Update”, IMA Consulting Newsletter, Jan 2009. (c) 2009 Revenue Strategies

  22. Contact Info… Stephen Forney, MBA, CPA, FACHE, FHFMAVP - Margin DevelopmentArdent Health Services Nashville, TN 615-296-3054 stephen.forney@ ardenthealth.com Bill Phillips, FACMC, CHCAssociate Professor Health Services Mgt. Geo Washington Univ. & VP & Chief Revenue Off Revenue Strategies 786-371-6493 billinfll@juno.com (c) 2009 Revenue Strategies

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