The National Medicare RAC Summit - Global Health Care, LLC
The National Medicare RAC SummitWashington DCMarch 5-6 2009Embed the RAC Programin YourRevenue Cycle Process
Adventist Health, Inc.Not-for-profit, faith-based health caresystemheadquartered in Roseville, CA, just east ofSacramentoAffiliated with the Seventh-day AdventistChurchCarol Richardson, MA, RHIAMarch 6 2009
Adventist Health, Inc. – Roseville, CACalifornia, Oregon, Washington and Hawaii 17 hospitals with 2800 beds – 13 in California 110,188 admissions 392,495 emergency department visits 1,969,779 outpatient visits 22 rural health clinics 15 home care agencies Clinics and outpatient facilities Three joint venture retirement centers (with a 4th onthe way) 18,000 employeesCarol Richardson, MA, RHIAMarch 6 2009
Adventist Health Site Map12345678910111213141516171819Carol Richardson, MA, RHIACorporate OfficeAdventist Medical Center, PortlandCastle Medical CenterCentral Valley General HospitalFeather River HospitalGlendale Adventist Medical CenterHanford Community Medical CenterHoward Memorial HospitalRedbud Community HospitalSt. Helena HospitalSan Joaquin Community HospitalSelma Community Hospital, Inc.Simi Valley HospitalSonora Regional Medical CenterSouth Coast Medical CenterTillamook County General HospitalUkiah Valley Medical CenterWalla Walla General HospitalWhite Memorial Medical CenterMarch 6 2009
Our Vision – RAC DemonstrationGoal #1Standardize management of RAC correspondenceand payment denials across facilities IdentificationTrackingManagementResolutionCarol Richardson, MA, RHIAMarch 6 2009
Our Vision – RAC DemonstrationGoal #2Establish coding audit of alleged coding errors and DRGchanges Select external coding vendor to perform all auditsImplement process for facilities to provide data tovendor¾ RAC correspondence¾ Coding summary/abstract¾ Physician coding query¾ Medical record¾ UB92Carol Richardson, MA, RHIAMarch 6 2009
Our Vision – RAC DemonstrationGoal #2Establish coding audit of alleged coding errors andDRG changes Develop communication tools for vendor,facilities and CorporateVendor draft rebuttal correspondenceVendor and Corporate HIM jointly review auditfindings and rebuttal decisions on weeklyconference callsCarol Richardson, MA, RHIAMarch 6 2009
Our Vision – RAC DemonstrationGoal #3Deliver coding education on RAC coding risk areasmonthly Vendor develop curriculum including case scenarios Coder pre- and post-testing Track with AH/MC Strategies Learning Management System Issue certificates of attendance Deliver seminar via WebEx Archived on Corporate HIM website on AH intranetCarol Richardson, MA, RHIAMarch 6 2009
Coder Education Seminars2006 04/06 – DRG 397, Coagulation Disorders 05/06 – DRG 217, Wound Debridement 06/06 – DRG 416, Septicemia 07/06 – DRG 468, Operating Procedure Not Related to Diagnosis 08/06 – DRG 124, Circulation Disorder 10/06 – DRG 478, Other Vascular Procedures 11/06 – DRG 475, Respiratory Diagnosis with Ventilator Support 12/06 – DRG 148, Major Small and Large Bowel ProceduresCarol Richardson, MA, RHIAMarch 6 2009
Coder Education Seminars2007 01/07 – DRG 76, Other Respiratory System Operating RoomProcedures 01/07 – DRG 82, Respiratory Neoplasms 02/07 – DRG 141, Syncope and Collapse 03/07 – Principal Diagnoses with Complications & Comorbidities 04/07 – Principal Diagnoses with Complications & ComorbiditiesCase StudiesCarol Richardson, MA, RHIAMarch 6 2009
Coder Education Seminars2007 (continued) 06/07 – DRG 193, Hepatobiliary Tract Procedure 07/07 – Operative Report Coding 08/07 – DRG 144, Other Circulatory System Diagnoses withComplications and Comorbidities 09/07 – DRG 415, Infections and Parasites 11/07 – DRG 174, Gastrointestinal Hemorrhage with Complicationsand Comorbidities 12/07 – DRG 296, Nutritional/Miscellaneous Metabolic DisordersCarol Richardson, MA, RHIAMarch 6 2009
Coder Education Seminars2008 01/08 – MS-DRGs 190/191/192, COPD 02/08 – MS-DRGs 291/292/293, Heart Failure and Shock 03/08 – MS-DRGs 299/300/301, Peripheral Vascular Disease w CC 04/08 – MS-DRGs 579/580/581, Other Skin Subcu Tissue & BreastProcedures 05/08 – MS-DRGs 602/603, Cellulitis 17 yrs. w/o CC 06/08 – MS-DRGs 193/194/195 Simple Pneumonia & Pleurisy w/o CCCarol Richardson, MA, RHIAMarch 6 2009
Our Vision – RAC DemonstrationGoal #4Implement system-wide RAC activity reporting tool Locate on system intranet Provide data entry access for facility RAC CoordinatorsDirectors, Patient Financial Services Capture 100% of RAC correspondence Provide view access for facility and corporateadministrationCarol Richardson, MA, RHIAMarch 6 2009
Our Vision for the Data BaseAuto-populate data Enter account number, From claims file, ƾMedical record number¾ DRG¾ Discharge date¾ Coder ID Enter account number, From DRG tables specific to facilityand yearƾDRG weight¾ DRG payment Enter account number, From remittance advice file, ƾDate recouped¾ Dollars recoupedCarol Richardson, MA, RHIAMarch 6 2009
Our Vision – RAC DemonstrationGoal #4Implement system-wide RAC activity reporting tool Data aggregation by facility and across systemFacilityCoderService Year FacilityDenial Reason VendorDRGCarol Richardson, MA, RHIAemployeeDollars RecoupedMarch 6 2009
Carol Richardson, MA, RHIAMarch 6 2009
Carol Richardson, MA, RHIAMarch 6 2009
Carol Richardson, MA, RHIAMarch 6 2009
Carol Richardson, MA, RHIAMarch 6 2009
Taking Advantage of the RAC PauseEnterprise Government Payer Data Base¾ AHRAC TrackerRefine data fieldsExpand reporting functionalityRetrain workforceOR?¾ BettermousetrapInternal IT expense to bring internal data base upto speed vs. expense of commercial productCarol Richardson, MA, RHIAMarch 6 2009
Taking Advantage of the RAC PauseRoll out standard, corporate policy and processforRAC management¾ FacilityRevenue Cycle Committee willmonitor and direct RAC activity as astandard agenda item¾ Facilitieswill adopt best practices in RACmanagementCarol Richardson, MA, RHIAMarch 6 2009
Taking Advantage of the RAC PauseStandard Enterprise RAC Policy Identifies key stakeholdersChief Financial OfficerHIM DirectorPatient Financial Services DirectorCase Management DirectorAncillary Department Directors Requires designation of Corporate & facility RACCoordinatorsCarol Richardson, MA, RHIAMarch 6 2009
Taking Advantage of the RAC PauseStandard Enterprise RAC Policy Requires Facility & Corporate Revenue CycleCommittees to oversee RAC process RAC data base Correspondence, rebuttal and appeal workflow Denial-type action plans Staff education State/Regional hospital association RAC usergroupsCarol Richardson, MA, RHIAMarch 6 2009
EnterpriseGovt Payer AuditData BaseCorporate ty gementDirectorPFSDirectorCarol Richardson, MA, tors CoordinatorMarch 6 2009
RAC Best PracticesTalk to Providers in the Demonstration Project¾Vendors and consultants know some things, but not all thingsDo your homework¾“The Medicare Recovery Audit Contractor (RAC) Program – AnEvaluation of the 3-Year Demonstration – June Evaluation%20Report.pdf¾“Statement of Work for the Recovery Audit Contractor ProgramNovember 7, 60c3229301aeec334c7eb4/2 J1RACSOW11-5-07VS2(3).docCarol Richardson, MA, RHIAMarch 6 2009
RAC Best PracticesBudget for¾RAC management FTE¾Outsourced Coding and Medical Necessity review¾Coder and Case Management education¾Adequate Release of Information manhours in HIM¾Counsel support in Formal Medicare Appeal ProcessCarol Richardson, MA, RHIAMarch 6 2009
RAC Best Practices Re-Evaluate your Release of Information Solution¾How tight is the current turnaround?¾ What accuracy rate is reported by your Quality Controlprocess?¾ Internal vs. Outsourced?If you outsource, consider a penalty against the invoice forany late or inaccurate RAC responseIf you’re considering outsourcing, some vendors are ableto incorporate document imaging which supports therebuttal and appeal process Track every piece of RAC Correspondence Name and empower the RAC Coordinator position Direct Revenue Cycle Committee to monitor RACactivityCarol Richardson, MA, RHIAMarch 6 2009
RAC Best Practices Require all Coders to be Credentialed Outsource Coding and Case Management audit Tighten Up Coding Vendor Contracts¾ Add penalty against invoice for retroactive payment denialsTighten Up & Expand Physician Coding QueryProcess¾Require that physicians be queried per AHIMA guidelines¾ Track and monitor query trends by physician, code/DRGand coder¾ Add pending queries to Medical Staff Bylaws, Rules andRegulations definition of incomplete/delinquent medicalrecordCarol Richardson, MA, RHIAMarch 6 2009
RAC Best Practices Meet every deadline - NO TECHNICAL DENIALS! Send ALL the RIGHT stuff the FIRST time Hold the RAC accountable¾ Processes¾ Timelinesas defined by CMS¾ CommunicationCarol Richardson, MA, RHIAMarch 6 2009
RAC Best Practices Rebut initial RAC decisions as appropriate Pursue formal Medicare appeals as appropriate Educate¾ Coders¾ Case Managers/Utilization Review Network with and through hospital associationCarol Richardson, MA, RHIAMarch 6 2009
Carol Richardson, MA, RHIACorporate Director, Health Information ManagementAdventist Health, Inc.2100 Douglas BoulevardRoseville, California 95661916-774-3369RicharCF@ah.orgCarol Richardson, MA, RHIAMarch 6 2009
2 Adventist Medical Center, Portland. 3 Castle Medical Center. 4 Central Valley General Hospital. 5 Feather River Hospital. 6 Glendale Adventist Medical Center. 7 Hanford Community Medical Center. 8 Howard Memorial Hospital. 9 Redbud Community Hospital. 10 St. Helena Hospital. 11 San Joaquin Community Hospital. 12 Selma Community Hospital, Inc.
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
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Apr 12, 2018 · RAC AGENDA – MAY 2018 . 1. Welcome, RAC Introductions and RAC Procedure - RAC Chair . 2. Approval of Agenda and Minutes - RAC Chair . 3. Wildlife Board Meeting Update INFORMATIONAL - RAC Chair . 4. Reg
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RAC audits can implement an organization-wide online training program on preparing for, responding to, and appealing a RAC audit. The organization's training coordinator can assign and track . Summit, the National Disclosure Summit, and the National Medicare Readmissions Summit. O ne of the most significant changes in the Medicare program .
