RAC tools promise audit assistance

By Eric Wicklund
10:39 AM

With nationwide implementation of the Centers for Medicare and Medicaid Services’ Recovery Audit Contractor (RAC) program less than a year away, healthcare IT vendors are flooding the market with products designed to help providers deal with audits.

Ingenix and Hyland Software are the latest to join more than 50 companies offering consulting services or software programs – or both – designed to help providers ferret out “improper” Medicare payments made to hospital providers, suppliers and physicians on claims paid since Oct. 1, 2007. Targeting an estimated $10 billion in annual improper payments, CMS has set a Jan. 1, 2010 deadline for all 50 states to have RAC programs rolled out.

“Data mining has been frustrating,” said Matt Wolocko, compliance officer at the Henry Ford Health System in Detroit, which implemented MRO’s RAC Tracker earlier this year. “Lots of software programs are out there tracking different things. We want software that’s specific, that tracks our RAC activities and helps us with any appeal process.”

“There are so many databases out there, and too often you get someone who says, ‘This is what you bought; this is what you get,’” he added.

Hyland Software, based in Westlake, Ohio, recently added the RAC Administration Solution to its OnBase enterprise content management suite of services. Susan DeCathelineau, Hyland’s manager of healthcare solutions, said the solution offers “a perfect fit” to providers who want to track audit documentation as well as access electronic medical records.

Tim Tegeder, who leads Hyland’s healthcare unit, said the RAC Administration Solution is an extension of the company’s existing audit management platform. “The tool is something we’re continuing to evolve” as more RAC details are released, he said. “We’re going to see a phased approach to this.”

MRO, based in King of Prussia, Pa., recently debuted Audit Tracker Online, which adds capabilities to its RAC product to allow for the management of all payer audits. Ingenix, of Eden Prairie, Minn., is offering a RAC module that’s designed to help providers dealing with any third-party audits as well as providing alerts to identify possible auditable items prior to billing.

“It’s a way to limit your financial exposure through all the processes that are going on,” said Laurie Johnson, the company’s consulting RAC expert. “It pays to be proactive right now.”

Bruce Hallowell, finance and revenue director at the Falls Church, Va.-based Computer Science Corporation (CSC), says hospitals are spending millions of dollars getting ready for the RAC program but aren’t necessarily spending money in the right places.

“Hospitals know what’s wrong. What they don’t know is what their exposure is,” he said. “They’re getting defensive, and that isn’t what they should be doing here.”

Hallowell said hospitals need to “look outside the box” in selecting RAC vendors and tools that not only compile data, but tell them what to do with it.

“Software is not a solution – it’s a tool,” he said. “Sampling is not going to give you the answer. This is not a time for hospitals to be shy about what they’re doing.”