How to manage is the third component of the P-E-M approach to dealing with RACs. It may be inevitable that hospices, perhaps yours, will eventually receive a demand letter or request for records from the contractor at work in your region. As soon as a communication from a RAC is received, time is of the essence. Hospices need to have in place a “RAC S.W.A.T. Team” that can mobilize immediately, prepare clinical records for review, make decisions regarding whether or not to appeal and implement a timely, comprehensive response to management of RAC activity. Part of the response to RAC activity must include navigating the Medicare appeals process through each level in as efficient and cost-effective a manner as possible.
An equally important RAC management activity will be to monitor what they are doing across the country. Given how these for-profit companies are compensated (the more money they recoup from providers, the more money they make), the potential for RAC abuse or overreaching is worrisome. To help everyone’s monitoring efforts, RAC Assistance for Hospice has developed a RAC Forum where registered users can share their experiences and learn from each other about RAC activities in their own and other regions.
The RAC Forum will be the place where readers can tell colleagues what types of reasons are provided for recoupments, success or lack of success at various levels of the appeals process, etc. Please help RAC Assistance for Hospice help you by registering for and contributing to this forum. The more information we can gather, the more we will be able to monitor the activities of each RAC and ensure that they are not abusing the enormous power that has been entrusted to them.
The articles and resources in the Manage category of RAC Assistance for Hospice are intended to help hospices develop a comprehensive management response to RAC activity.
