Streamline RAC and other Medicare Audits
with InSight Audit™
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.
Cover Medicare Audits and More: RAC, MIC, CERT, MAC and ZPIC
The permanent RAC program is well underway and an alphabet soup of other audit programs are either already in place or coming soon, including:
- Medicare Comprehensive Error Rate Testing (CERT)
- Zone Program Integrity Contractor (ZPIC)
- Medicare Administrative Contractor (MAC) audits
- The Medicaid Integrity Contractor (MIC) audits
- Office of Inspector General (OIG) audits
- Commercial payor audits
Be ready for the increasing volume of audit activity with Insight Audit, a comprehensive, web-based audit management tool that manages all of your medical claims audits and workflows from one central location.
Designed for Audit Success
InSight Audit is a web-based tool for creating the core audit tracking and correspondence database required to minimize exposure and give hospitals the best chance for appealing audit denials. It marries easy-to-use data entry tools with workflow and reporting capabilities designed specifically for navigating the multiple levels of inquiries and appeals. Securely accessed from any browser, it provides intuitive views of all entries, tracking audited claims from chart request all the way to Federal District Court (FDC) appeal.
As part of the InSight Revenue Cycle Solution, InSight Audit can also be integrated with the full 835 interface engine included in InSight Denials. This provides automated access to audit-related remittance data, including the N432 Remittance Advice Remark Code that monitors payment adjustment information from audits.
Manage Workflow Across Multiple Departments and Locations
InSight Audit features a comprehensive workflow tool that distributes required tasks across multiple team members, departments, and facilities as needed, updating the status of all components in the central patient record as it goes.
Integrated reporting tools make it easy to track each element of the process and ensure individual accountability at every step in the workflow.
Users can upload and attach all documentation associated with each appeal such as denial letters, appeal letters, and decision letters. The tool automatically compiles a complete history for each appeal, encompassing the full communication trail.
Reporting
As part of the InSight Revenue Cycle Solution, InSight Audit integrates with InSight Reports to enable staff to quickly identify and trend areas of exposure and multi-level appeals. Reporting capabilities include the ability to calculate all applicable due dates, and create shared reports and team alerts for meeting key deadlines. InSight Audit is AHA RACTrac certified and can generate a wide range of status reports, including information on:
- Denial reasons
- Retractions
- DRG/CPT
- Executive summaries
- Appeal levels
- Outcomes
- Risk
- Workflow productivity
- Enterprise reporting
Knowledgebase
InSight Audit and the entire InSight Revenue Cycle Solution leverage a fully web-based platform which is constantly updated to include the latest information on best practices and payment rules discovered by Craneware InSight's RAC Consultants. Within that large and growing knowledgebase is a set of content including templates, checklists and relevant information, including:
- Correspondence templates
- Complete record checklist
- Relevant forms
- References for winning arguments:
- Medicare regulations
- Social Security Act
- Prior precedent in overturned appeals
