Improving Clinical Documentation to Mitigate RAC's Impact

The Center for Medicare and Medicaid Services' (CMS) Recovery Audit Contractor (RAC) Program is designed to identify, reduce and recoup improper Medicare payments through post- and pre-payment audits.

Under the traditional RAC program, auditors are tasked with reviewing claims on a post-payment basis to identify overpayments to Medicare providers and underpayments from CMS. Under the RAC Prepayment Review Demonstration Program, launched in 2012, RACs in select states are reviewing claims based on a handful of DRGs before they are paid to ensure providers follow all Medicare payment rules.

RAC Audits Present a Number of Key Challenges for Hospitals, Physician Practices and Other Healthcare Providers

Many of the RAC challenges facing healthcare organizations are rooted in inadequate documentation practices. Specifically, documentation must support that care provided was:

  • Medically necessary and appropriate
  • Meeting Medicare coverage requirements
  • Properly documented and correctly coded and billed

Without thorough and accurate documentation, providers will find it difficult to efficiently and effectively defend against RAC audits, and are left financially vulnerable.

ProVation® MD Mitigates the Impact of RAC

Automating procedure documentation and coding ensures physicians have compliant documentation to defend claims, thereby accelerating the audit process and avoiding unnecessary financial shortfalls.

  • Menu-driven documentation processes enable fast, easy capture of compliant data at the point of care and subsequently drives compliant, coder-ready documentation.
  • Structured and compliant data capture eliminates human errors that can lead to incomplete documentation and incorrect coding.
  • Guided documentation flags specific data for verification and reduces the likelihood that important details are missed in the documentation process.