The Centers for Medicare and Medicaid Services (CMS) posted on the RAC Web sites the first new issues of completed reviews in early August.
Providers will use the reviews and the Office of Inspector General’s audit roadmap to create or fine-tune internal processes for the Recovery Audit Contractors (RAC).
CMS has not issued any guidance to providers in terms of using IT to help with compliance and auditing nor does it recommend software, said Connie Leonard, director of Recovery Audit Operations.
Some providers, however, are looking to IT to automate processes and mitigate risk.
St. Vincent Catholic Medical Center is deploying MedeAnalytics’ reporting and Quality and Compliance components to help evaluate its risks and develop corrective action, said Barbara Piascik, senior vice president and chief compliance officer.
St. Vincent will be able to look at its workflow and make sure the data is trusted and being used effectively.
“Information is only valuable if the right people see it, especially for compliance and self-discovery,” she said. “If an overpayment is found, the right people will take action.”
St. Vincent will see ROI in its ability to take corrective action and avoid external penalties and audits, which require additional resources, she said.
MedeAnalytics is seeing a “fairly even split” between providers that are choosing a self-developed, departmentally controlled Excel or Access database to track audit activity and an IT department-dependent solution, said Griffen Jacobsen, director of provider solutions product marketing.
Organizations are also focused on either tracking and managing the RAC process or using an analytics solution to mitigate risk, focus resources and drive process improvement before the RAC letters arrive, he said.
An example of a pre-emptive action is the discovery of a trend over time of final claims having a higher-weighted and therefore higher-reimbursement DRG (diagnosis related group) over lower-weighted DRGs in the same clinical category.
A MedeAnalytics customer discovered such a trend at one of its facilities. The customer was able to drill down into the data to identify the coder and physician, and determine the need for education or better communication.
“This gave them the opportunity to evaluate the situation, make process changes and take any remedial action necessary before a regulatory audit brought it to their attention,” Jacobsen said.
