Recovery Audit Contractors Management

Recovery Audit Contractors Management

Streamline the process of complying with RAC audits.

The passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010 significantly altered the regulatory landscape for the U.S. healthcare industry. Among other key provisions, the expansion of Recovery Audit Contractor (RAC) audits raises expectations for efficiency and accountability for healthcare systems of all sizes.

Building upon previous legislation that established the RAC audit program, PPACA requires states to engage a RAC contractor to review Medicaid reimbursements, and extends the RAC program scope to include Medicare Parts C and D. This presents a number of challenges for healthcare providers:

  • The complexity of managing the process, coupled with the larger amount of possible audit requests, demands that providers invest additional resources in responding to record requests, compiling appeals, and managing deadlines.

  • Missed deadlines or submission of incomplete evidence may require repayment of Medicare or Medicaid funds.

  • Providers may lack the necessary tools for analyzing audits and gaining insights that can help them remain compliant with RAC initiatives.

A RAC Audit Management solution from a Microsoft partner can help you address these issues. Because they are built on familiar, flexible, and widely available Microsoft technology, the solutions support cost-effective and seamless interoperability among your existing systems and data. At the same time, they can provide valuable benefits in meeting the expanded RAC audit mandates:

  • By enabling audit-related workflows and consolidating data, audit compliance is streamlined to reduce response times and to help ensure that all necessary documentation is provided by deadline.

  • Content-management features help to improve compliance with RAC business performance guidelines by tracking organization-wide knowledge.

  • Consolidation of the data collection process helps providers to defend claims through the appeals process.

  • Advanced data integration and analysis tools provide contextual insights into audit performance that can help organizations identify current issues and avoid future problems.