RAC Audits -- What to do when they happen in Home Care and Hospice
Many Home Care agencies are facing CMS RAC Audits. Let's face it they are fishing for fraud. That said the main thing to do is to NOT PANIC. Just because you are under review does not mean you are doing anything wrong.
First thing to keep in mind is why you were selected. The answer is not exactly clear, but can be described as that there is something about your utilizations which outside of average for your geographic area or Nationally. So if you have a special Hip Replacement program you may well be targeted because that program requires more therapy than providers without it. But as you can see, that program may well justify the additional therapy.
What to do?
1) As noted Don't Panic!
2) Budget in the lose of revenue for those cases that are under review. CMS holds the money on these cases. The money may well be held for 60-90 days from when you provide them the requested documentation.
3) Review the documentation before you send it... make sure you are thorough and there are no missing pieces. Missing notes will be percieved as a fradulant omission so even a bad note is better than no note. PROVIDE THE DOCUMENTATION IN A TIMELY MANNER.
4) Do not radically change your processes overnight. Remember, you are not necessarily doing anything wrong. Radical changes in process can be percieved as an admission of guilt. Even if there is nothing wrong.
5) Hire a consultant to review your a) documentation processes b) your overall policies and procedures. It is ok to change you business models. But make educated decisions.
6) Did we mention dont panic.... well even if you are found at fault use your concultants to review the processes and come up with a plan of action to correct it. Also know your rights. You have the right to appeal any decision they make.
We at White Oak are dedicated to helping our customers and our community. Please remember that Software like HomeRun can help you in situations like these, but that HomeRun is a tool and is only as good as how you use it.