Using Your ECM System to Simplify RAC Audits

To an outsider, usually the indication of an outstanding healthcare facility is one that excels at patient care. Indeed, this is the ultimate goal of any healthcare organization. Patient service, however, goes far beyond the skill and expertise of your physicians, nurses, lab technologists, and support staff. If you are involved in any way with the administrative end of a healthcare facility, you are well aware that there are many factors that have to converge behind the scenes in order for a facility to operate effectively. Admissions, billing, registration, etc.—all have to be running effortlessly in order to serve patients effectively. A critical component to smooth operations and stellar patient service is the ability to locate, access, and disseminate information.

Efficient information storage, access, and retrieval are integral components to a healthcare facility—now more than ever. Recovery Audit Contractors (RACs) are mobilizing. And if your organization is unable to produce documentation upon request within the timeframe specified by CMS, you may be at risk for significant penalties. Failure to comply with auditors’ requests will lead to determinations of overpayment. RAC audits can be expensive on several different levels. Healthcare facilities have to be able to:

• Locate materials that are requested by auditors
• Respond to audits within strict timelines
• Manage significant numbers of concurrent appeals
• Assemble the manpower to address RAC audits

Using ECM to make information accessible

An enterprise content management (ECM) system allows healthcare organizations to transition from paper-based processes to electronic. In doing so, it helps to alleviate many of the challenges that are associated with RAC audits. An ECM system allows you to store all of your records and associated information in a centralized electronic repository. There is no danger of lost, misplaced, or duplicated patient records. Documentation associated with coding assignments, determination of medical necessity, and other materials to support claims can be located, accessed, and made available securely to auditors with the click of a mouse.

The RAC appeal process is often lengthy, and can be complicated by the sheer volume of requests and outstanding appeals. Timely response and management requires cooperation and communication between the many departments of your enterprise. With an ECM system, authorized staff can access critical documentation securely, from any web browser. This allows you to comply with RAC auditors’ requests and minimize your need for extensions.

Managing high volumes of information

To effectively manage RAC audits, organizations have to be able to adhere to strict timelines. In addition to producing records upon requests, administrators will also have to closely follow the progress of high volumes of claims as they make their way through the appeal process. Failure to do so will render claims ineligible for reimbursement.

ECM can help healthcare facilities track claims. This eases the administrative burden that is associated with deadlines and appeals. Workflow can automatically notify individuals if they need to carry out specific tasks with a designated timeframe. It can also help with the compilation of documents that are required to support appeals.

ECM throughout the enterprise

The ability to access information immediately simplifies RAC audits significantly, but it also offers benefits that resonate throughout the organization. ECM software can interface with existing EMR/EHR systems to enhance patient records and ensure that they are comprehensive. ECM can also be used on the HR side to organize, access, and process staff records along with their clinical documents.

A transition from paper records to electronic processes ensures that patient records are complete. At the same time, it improves compliance with HIPAA, SOX, and other regulations. The ability to store forms, faxes, electronic communications, images, and other documents in a single searchable repository ensures that patient—and staff—information is no longer lost, misplaced, or duplicated. Patient records can be accessed remotely—from multiple locations—by authorized personnel from any standard Web browser, which improves diagnosis and care.

The time is now

Healthcare facilities are being required to implement electronic processes and replace paper within the next few years. Financial resources to help smooth the transition are available now. Unfortunately, facilities that have already adopted electronic medical records are finding that EMR/EHR systems, while good at managing clinical information, are not necessarily equipped to manage documents. An ECM system addresses that shortcoming and allows healthcare facilities to get more functionality from their existing investments in technology.

RAC audits are going to challenge healthcare facilities. There is no getting around that reality. Failure to comply with auditors, by default, designates claims as overpayments. To respond effectively, organizations need to enact a tiered approach. In addition to using ECM software to manage RAC audits, healthcare facilities should

• Form a multidisciplinary team for effective RAC response
• Respond to RAC letters promptly
• Review overpayment determinations
• Track requests and ensure that deadlines are met
• Conduct internal audits
• Make adjustments to processes to avoid future overpayment determinations

An investment in ECM software can prepare you for the oncoming reviews and enable providers to present documentation well within the 45-day response period. ECM as a records management tool is unparalleled. Consider the other benefits that it could provide to your facility— whether yours is a small practice or a large hospital. At the same time that it helps you manage RAC audits, an ECM system can serve as a foundation for improved efficiencies and compliance measures.

For more information or to schedule a demonstration, please Contact DocFinity now.