RAC and the OnBase RAC solution for healthcare audits
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Transcript of RAC and the OnBase RAC solution for healthcare audits
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The OnBase RAC Administration Solution
Helping organizations manage the Recovery Audit Contractor (RAC) appeal process
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What is a Medicare RAC Audit?
• RAC = Recovery Audit Contractor
• Organizations impacted – bill for Medicare Parts A&B
• Find and correct improper payments under the Medicare Fee For Service program– Coding errors– Duplicate charges– Medical necessity
Goal = Protect the Medicare Trust Fund Prevent fraud, abuse and waste
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RAC Audit Timeline
• RAC Demonstration Project
Pilot project designed to see if RACs would be a cost effective way to recover incorrect payments to providers
• Spring 2005 – March 27, 2008
• States audited: New York, Massachusetts, Florida, California, Arizona and South Carolina
• Spring 2008 – 4 permanent RACs selected – CGI Technologies and Solutions, Inc.
– Connolly Consulting Associates, Inc.
– Diversified Collection Services, Inc.
– HealthDataInsights, Inc.
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Impact on Hospitals/Providers…
Results from the 3 year demonstration program (included 6 states):
• $992.7 million in Overpayments collected
• $37.8 million in Underpayments identified
• $46 million Overturned on Appeal
• $215.3 million Program Cost
NET =
$693.6 million returned to Medicare Trust Fund
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Types of RAC Reviews
• Automated– National Claims History Files software utilized (Data Mining)– Identified certain overpayments
• Service not covered• Incorrect coding• Duplicate procedure
• Complex– Claims History Files– Suspicious for overpayments– Copies of medical records requested and reviewed
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Schedule
Implementation nationwide January 1, 2010
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OnBase RAC Solution• Designed to manage the provider’s appeal process to the RAC
auditor and the denial of medical claims– Task Management
• Track responsible employee assigned to each task– Configurable Parameters– Tracking functionality
• Shipping information• Expected completion dates / appeal timelines• Medical record request costs• Interest due on recovered funds• Communication with RAC personnel
– Upload Claim History
• Dashboard Views:– Administration/Management– Financial – Risk Analysis– Process Improvement
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Software Technology Firm established in 1991
Privately-held, 65% by family and employees
Over 900 employees
More than 9,000 Clients
OnBase®
Enterprise Content Management (ECM) Software
Serviced through a combination of channel partners & Hyland direct
Hyland Software Inc. Software Inc.
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Exclusive endorsement from the American Hospital Association (AHA) for its Integrated Document Management system
OnBase RAC Administration Solution = RACTrac Compatible Vendor
On a Scale of 1 – 9 - Worth the effort: 8.08Would you buy it again?
100% customer satisfaction
Industry Recognition
ACE Award for Best Document Management Application in Healthcare
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Comprehensive, Integrated Modular Solution
Highest Level of Configurability
Ease of Integration
Open, Secure & Scalable Architecture
Quicker & Realistic Deployment Times
Lower Cost of Ownership
Award-Winning Implementation Methodologies
Healthcare Specific Modules and Expertise
The OnBase Difference
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OnBase RAC Solution – Additional Information
http://www.Hyland.com
Industry Solutions → Healthcare → RAC Audit Solution
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Search for Recovery Audit Contractor
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time to make a difference.