RAC Audits
Update: Craneware InSight is one of a small handful of vendors selected for the Electronic Submission of Medical Documentation (esMD) pilot program. We are currently in application development and testing. Our pilot group is currently scheduled for a go-live in early 2012. The esMD program will enable customers to electronically send medical records to their RAC, MAC, or other participating Review Contractor. The second phase of the program will allow RACs and other Review Contractors to electronically send chart requests to hospitals. As we are part of the pilot program, Craneware InSight will be one of the first vendors to offer phase 2 functionality as well.
Medicare's Recovery Audit Contractor (RAC) audits have turned the market upside down with nearly one billion dollars taken back by Medicare in the demo phase alone, and it is now becoming one of the biggest financial challenges and administrative burdens for hospitals across the nation. While the demo phase national average for successfully appealed claims was only 1 out of every 3 appeals,1 Craneware InSight's clients won more than twice as many appeals than their peers nationally, avoiding millions of dollars in unnecessary Medicare RAC denials.
InSight Audit
We've leveraged our RAC consulting experience and success into InSight Audit, the industry's premier RAC and medical claims audit software offering.
- Turn-key tracking and appeals for all medical claims audits, including RAC, CERT, ZPIC, MAC, MIC, OIG and other Commercial payor audits.
- Knowledgebase supplies winning appeal templates, strategies and case law.
- Designed from real-world RAC demonstration project experience.
- Streamlines workflow and stores all documentation by patient.
- Provides robust reports to analyze and trend areas of exposure and multi-level appeals.
- InSight Audit is AHA RACTrac Certified.
- See for yourself - Request a Demo.
RAC Consulting Services
When it comes to RAC, you need expert guidance to navigate the murky and changing rule of a process that could cost your organization millions of dollars in already recognized revenue. We know the appeals process, we are already working it for your peers and we know how to work it for you.
Craneware InSight also offers RAC Appeal Services designed to get your organization out of the reactive guessing game of responding to appeals and into the proactive mode of establishing defensible policy and making Medicare's RAC auditors prove where you went wrong. We'll help you write the rule book instead of having it thrown at you.
1 CMS The Medicare Recovery Audit Contractor (RAC) Program: Update to the Evaluation of the 3-Year Demonstration, January 2009)
