RAC AUDIT PROGRAM

1. RACSource Business Intelligence and Appeals
   SOURCECORP RACSource, a financial management and appeals analysis tool, is a state-of-the-art ASP offering developed by leveraging SOURCECORP’s extensive experience in denial management, coding and compliance auditing. Its efficient workflow, extensive and customizable reporting, and real time dashboards provide unprecedented efficiency in dealing with RAC. More than a tracking tool, RACSource is a comprehensive software and analytic solution providing real time prompts, reminders and alerts that ensure timelines and deadlines are never missed. More importantly, RACSource provides a vehicle for a detailed, specific analysis of the ongoing vulnerabilities of your facility to RAC denials.
2. RAC Enablement and Education
   The RAC program will impact your facility at multiple touch points throughout your continuum. It is imperative that your organization eliminates breaks and redundancies in your process. We will assess your organization’s readiness to successfully manage RAC, including everything from:
   • Who gets the envelope with the record requests.
   • How your RAC Defense Team is organized.
   • How you monitor your success with the appeals process.
   • What departments are assigned accountability.
   We will facilitate your creation of customized workflows with corresponding policies and procedures, which are critical to avoiding unnecessary denials due to RAC response failures.
   
   Process integrity, however, cannot stand alone. Effective documentation and accurate coding are essential components to support medical necessity and clean claim submission. Engaging key players in the process through education is essential to your success.
   
   In general, all physicians, case managers, registration personnel, coders and hospital staff need a heightened awareness and education to the touch points of your RAC process. Our educational components can be implemented together as a complete program, or as individual initiatives that address specifically identified objectives.
   
   SOURCECORP HealthSERVE’s extensive track record during the demonstration period makes us uniquely qualified to assess your readiness. We will work with you to implement an enabling plan, including customized education and training for successful change management. Our seasoned staff of professionals stands ready to help your organization experience the same level of success.
3. Coding and Documentation Audit for Risk Assessment
   SOURCECORP HealthSERVE’s credentialed coding auditors will perform a full risk assessment comparing your facility’s actual data against known RAC targets. We will assist you in identifying and correcting improper Medicare payments due to coding, documentation and medical necessity issues. Once your areas of high risk are identified, we provide you with the expertise and information necessary to activate corrective action measures.
   
   We can also assist with the medical record review of RAC denials and RAC appeal preparation.
4. Medical Necessity Assurance
   Successful management of RAC, or other payer denials, is not based on an "after the care" retrospective defense. The true solution to effective denial management is preemptive and concurrent, during the patient’s admission and treatment. We help to identify and reduce your vulnerability by putting best practices and processes in place to prevent errors prior to patient discharge and claims submission. 
5. Revenue Retention and Recovery
   SOURCECORP HealthSERVE will complete a hospital specific analysis of your Medicare underpayment and overpayment status. This report, based on our initial analysis of your hospital’s current performance, will gage where you stand on the current compliance scale. Our concurrent and retrospective focus on underpayments, in conjunction with our RAC defense analysis, provides an opportunity to reduce the financial impact of RAC denials.
   
   SOURCECORP HealthSERVE will receive and process your RAC denial letters and meet your rebuttal and appeal timelines. We can assist in writing and submitting appeal letters as an extension of your RAC team. We can assume complete responsibility with an outsource agreement.