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Hometown Health

Hometown Health. The Team Discovery story www.discoveryhrs.com. HTH RAC UPDATE. 9/24/2014. 9/24/2014. 2. 2. HTH RAC READINESS PROGRAM SUMMARY. Monthly webinars (4 th Wed at 10am) to educate hospital staff and hear from the experts on ongoing  MAC/RAC activity.

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Hometown Health

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  1. Hometown Health The Team Discovery story www.discoveryhrs.com

  2. HTH RAC UPDATE 9/24/2014 9/24/2014 2 2

  3. HTH RAC READINESS PROGRAM SUMMARY • Monthly webinars (4th Wed at 10am) to educate hospital staff and hear from the experts on ongoing  MAC/RAC activity. • 12 MMM Monthly Webinar Topics - Beginning in May 2009 9/24/2014 HomeTown Health RAC Readiness Program Summary – funded thru SHIP and individual hospital funding at $500/mo 9/24/2014 3 3

  4. HTH RAC READINESS PROGRAM SUMMARY HomeTown Health RAC Readiness Program Summary • Milton & Associates – Sherry Milton • I/P Medicare Documentation and Coding Compliance Review • 4 Medicare /RAC Compliance Courses • Everything You Need to Know about Medicare Appeals • RAC Inside OutNow available in School of Patient Financial Services on HTHU! • Responsibilities of the RAC Team • Medicare Billing Compliance by Draffin & Tucker 9/24/2014 4

  5. HTH RAC READINESS PROGRAM SUMMARY • On-site RACS training for Board, Dept Heads, & Staff  • Completed by Robert Finley & Kathy Whitmire •  ACCESS TO HTH RACS RESOURCE WEBSITE AT  • www.racshelp.com 9/24/2014 HomeTown Health RAC Readiness Program Summary 9/24/2014 5 5

  6. HTH RAC READINESS PROGRAM SUMMARY 9/24/2014 4) ACCESS TO HTH RACS RESOURCE WEBSITE AT  • www.racshelp.com 9/24/2014 6 6

  7. HTH RAC READINESS PROGRAM SUMMARY 9/24/2014 5) RAC Appeals & Denials Management Oversight - Dale Gibson and RAC Team will provide education and oversight into the complex area of managing the requests for records and the 5 step appeals process. RAC Readiness Program /SHIP & Private Funded thru 8/31/10 HomeTown Health is proud to be a part of this high caliber team of Medicare experts that can help our rural hospitals prevent large RAC takebacks with a preventative proactive solution! 9/24/2014 7 7

  8. A Good Offensive Strategy Is Your Best Defense Against RAC/MACTake Backs 9/24/2014 Surviving the Claims Audit take backs will require a strong offensive line to protect your interest in advance of the RAC / MAC  Medical Record review.  Instead of suffering financially from large takebacks or fighting a costly battle to appeal a RAC demand, make a small investment to protect your hospital's assets up front. 9/24/2014 8 8

  9. Questions that all hospitals should be able to answer: 9/24/2014 Who is managing your RAC Medical Record Request?  Is it a ROI company that has experience with Medicare Recovery Audit Contractor requirements?  Who is reviewing your documentation to ensure that it  fully supports the DRG or Admission diagnosis? Is your record in an electronic format stored so that it can accessed for review prior to sending? Are you able to track your record online with your current ROI company and access it electronically if changes need to be made? With the high dollar amounts on many RAC DRG & Medical Necessity takebacks, do your local attorneys have the expertise to defend you in higher level RAC appeal hearings? 9/24/2014 9 9

  10. HTH RAC TEAM OFFENSIVE STRATEGY 9/24/2014 PLAY #1  Team up with Discovery Health Record Solutions to manage your RAC requests and provide electronic access to your requested records. PLAY #2 Meet with your RAC Offensive Line to determine where your weak points are in supporting documentation and ensure that those points are covered in your submission with Milton & Associates PLAY #3 Huddle with your coaches, led by Dale Gibson, Medicare Reimbursement Expert to make sure you have the right game plan in place to help you win. PLAY   #4 If you need backup or get behind in the game, then call in the first string with Morris, Manning & Martin Healthcare Attorneys - Experts in dealing with Medicare Audits and reimbursement compliance. 9/24/2014 10

  11. Company Overview 9/24/2014 Atlanta, GA headquarters since 1998 Service over 1000 medical facilities National operations - 35 states today 30% + annual growth rate DiscoveryHealth Record Solutions fulfills requests for medical records for healthcare providers, and release patient information to authorized internal and third-party requestors like insurance companies and attorneys, which is compliant and secure. Discovery increases customers’ productivity, profitability and reduce their risks associated with releasing medical information. 9/24/2014 11 11

  12. Discovery’s Services: • We provide a selection of complimentary, affordable, and effective medical record related services… • Release of Information Services (ROI) • Recovery Audit Contractor (RAC) • Revenue Collection Support (RCS) • Health Record Hosting (HRH) • Other services • Scanning and back–file conversions • Disability form management 9/24/2014 12

  13. Discovery's Benefits: • Saving a hospital $20,000 for a 25 bed facility • Eliminate request backlog • Eliminate processing “peaks and valleys” • Eliminate annoying requestor calls • Eliminate invoicing & collection calls • Reduce HIPAA compliance risk & costs • Reduce direct and hidden costs • Rapidly changing environment • Electronic delivery requirement • Fluid legislative environment • Reallocate resources • $’s and FTE’s on core responsibilities Our focus Health Records – Your focus Healthcare 9/24/2014 13

  14. Total Outsourcing: • Discovery field staff logs all “billable” and “non-billable” requests into StatusNOW • Records are uploaded to Discovery for processing within 24 hours • Discovery provides 9 pt Q&A for accuracy and distributes in paper or electronic format to requestor • No prepayment requirement • Customer service accepts all requestor inquiries regarding request status • Accounting issues invoices & initiates collection • Discovery provides unlimited access to StatusNOW for tracking/reporting 9/24/2014 14

  15. RAC Options • Option 1: RAC requests are processed, tracked, mailed and invoiced by Provider (Discovery Record Specialist is not involved in process) • Option 2: Discovery Health Record Specialist handles printing records from EMR system/systems, print and hand deliver to RAC dept. for processing • Option 3: Discovery Health Records Specialist will scan RAC request, document on provider tool, pull requested records and make available electronically for RAC dept. approval/processing • Option 4: Discovery Health Record Specialist will scan in RAC request, pull records both electronically and from paper chart, create work order in StatusNOW and Provider RAC tracking tool, upload records to Discovery for further processing, after approval by RAC Coordinator, burn to CD and ship via UPS tracking with request for signature

  16. RAC Options Option 5: RAC Team provides pre-review payment audit/DRG validation Option 6: Recoupment Strategy - Rebilling Services available from Dale Gibson based on the needs of each facility at an additional 25%. Option 7: Legal services available from RAC Team Attorneys Morris, Manning & Martin. 9/24/2014 16

  17. RAC Discussion • IMPORTANT POINTS TO BE MADE: • Hospitals are sending records to RAC/MAC with no way to track records, delivery          • Tracking mechanism required to prove that record is sent and received • Hospitals are only reimbursed one time at .12 per page – • Not for additional copies at each level of appeal • MACS are posting ADR's online and there is no letter sent • Discovery has two different systems for ROI requests and audit requests and defined differently - • We need to deal with virtual ADR;s on the Medicare DDE system. • Discovery Field reps can log on with Medicare biller to pull down virtual ADR's 9/24/2014 17

  18. RAC Financials • Provider to be reimbursed $.12/page and cost of USPS Shipping by RAC • Option 1: No Charge • Option 2: Provider will reimburse Discovery at month end $.12/page for processing • Option 3: Provider will reimburse Discovery at month end $.15/page for processing • Option 4: Provider will reimburse Discovery at month end $.15/page, $7 per CD and actual cost of postage for processing 9/24/2014 18

  19. RAC Financials • Option 5: RAC Team pre-review payment audit/DRG validation at $250/claim or 5% of total claim reviewed. • Option 6: Rebilling Services available from Dale Gibson based on the needs of each facility at an additional 25%. • Option 7: Legal services available under seeperate agreement from Morris, Manning & Martin.

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