Choosing the Right RAC Tool

In this episode, we cover ten important questions you should ask before selecting a RAC software vendor.

Transcript of the Podcast:
Hello and welcome back to the ClaimTrust RAC Insight podcast, brought to you by ClaimTrust, the leader in software tools and consulting services that help hospitals get paid for all of the work they do.

This podcast is part three of our three part series on “Top Tips for RAC Success”.  It covers our top, highly valuable but sometimes overlooked tips for helping your organization successfully take on the RAC challenge with the most efficient use of your resources. 

This final podcast in our series, Top Tips for RAC success, will discuss how to select the right RAC tool. The RAC appeal process will be extremely time and resource intensive for your organization.  It will require complex workflows and approval cycles. It is subject to frequent changes as the process evolves over time.  While it may be possible to design homegrown processes and tools to support your internal teams as they meet the RAC challenge, there are also a growing number of tools available to help organizations improve their RAC appeal results and handle the process most efficiently.

We definitely recommend using a tool, but all RAC tools are not created equal.  Here is our list for the top ten “must haves” in a RAC tool:

#1: Knowledgebase

The most important thing you can get from a tool is knowledge.  Every time you go through a RAC appeal, you gather valuable data about what letter formats and content work best, what appeal strategies are successful, what documentation is most compelling, etc.  A good RAC tool will come with letter templates, appeals strategies and other content to arm you with the information that only experience can provide.

#2: Workflows

RAC appeals can involve many departments and individuals collaborating to meet multiple deadlines.  Keeping track of those hand-offs while ensuring procedural compliance and timely filings requires the help of a RAC tool with solid workflow capabilities.  Look for tools that have both pre-built workflows as well as the flexibility to modify or design processes to fit your organization’s specific needs.

#3: Hosted software as a service model

RAC is a moving target.  Requirements will change, new rules and criteria will be added, and new best practices and appeals strategies will emerge over time. Keeping up with changing requirements and incorporating new best practices is very difficult to do with software that arrives on CD.  Hosted applications offer frequent content and functionality updates as well as fully-functional remote access for your team.

#4: Easy-to-use, streamlined interface

Your RAC team will need to include some of your organizations’ most experienced content and coding resources, but those people are likely to have a range of technical skills.  Good RAC tools need to be fast and easy to use, with controls that are intuitive-enough for non-technical users.

#5: Due date alerts

Any decent RAC tool should embed all of the relevant RAC deadlines in the workflows and provide alerts as deadlines approach to ensure timely submissions.

#6: Scanned document repository

We recommend scanning all relevant documents, both to allow electronic submissions and to eliminate the potential workflow bottlenecks associated with a paper chart.  A solid document repository for organizing and accessing all of the scanned documents associated with each claim is essential.

#7: Reporting capabilities

Good reporting will keep your RAC team on track and your administration up to date.  Look for reporting functionality that will allow you to produce reports suitable for both audiences with appropriate metrics and levels of detail for each.  You will want to be able to report on key metrics, including dollars retracted, dollars at risk, and most common denial reasons.  Also look for more advanced reporting capabilities like judge profiling, deadline reports, and results by DRG and CPT.

#8: HIS and Revenue Cycle integration

Your HIS and revenue cycle systems will be important sources of data for your RAC appeal process.  A RAC tool that easily integrates with these systems and can automate the process of data exchange with them will save time and eliminate potential human error.

#9: Support for multiple levels of appeal

As your RAC appeals reach the higher levels of appeal, new requirements will come into play - more documentation, new deadlines, information exchange with physicians and attorneys.  Many tools max out at the ALJ level.  Look for tools that will track your audits and provide supporting workflows for every level of appeal.

#10: Support for additional audits

Unfortunately, RAC is not the only kind of audit you need to be prepared for.  The Medicaid Integrity Program, CERT and OIG audits all have their own specific processes to follow and deadlines to meet.  The best RAC tools will also be designed to support these and other audits with built-in and customizable workflows.

Don't forget about InSight Audit, ClaimTrust's RAC Audit software.