A Big Picture View of Hospital Financial Standing Is Key to RAC Audit Preparation

Jennifer Dennard, E-Media Marketing Specialist
May 6, 2010


While designed to help combat instances of Medicare fraud, the Recovery Audit Contractor (RAC) program recently implemented by The Centers for Medicare & Medicaid Services (CMS) presents many challenges for hospitals and other healthcare organizations.

The program, which offers a cost-effective way of identifying Medicare underpayments and overpayments, now encompasses all 50 states. It's sweeping reach has prompted hospitals to usher in a number of proactive, yet time- and resource-consuming changes: instituting self-auditing programs and protocols; developing in-house processes to manage and respond to RAC medical record requests, reviews and determinations; and learning how to navigate through the RAC appeals process. Many organizations have even created leadership positions that deal solely with preparing for and working with RAC audits.

Market research indicates that a main concern of hospital employees familiar with the RAC process at their respective organizations is the impact an audit could have on their hospital's bottom line.  Many providers are seeking the aid of outside firms to help better prepare them for the audit process and help minimize any potential losses incurred as a result of a RAC audit.

As healthcare organizations institute new programs and work to understand and react to RAC regulations, vendors are working to understand institutions' financial positions, both going into and as a result of the audit. Third-party financial data resources, such as the Billian's HealthDATA Portal, help facilitate a connection between hospitals in need of audit assistance and healthcare finance firms offering resources to help them successfully navigate the process.

Using these in-depth financial data sets allows healthcare vendors to identify pain points in facilities, leading to a better understanding of the customer. This proactive approach on the part of healthcare vendors enables them to bring customized, best-fit solution offerings to the table from the word go. This diminishes the amount of time healthcare organizations must invest in the search for answers, putting them that much closer to implementing a RAC audit strategy.

About Billian's HealthDATA
Since 1953, Billian's HealthDATA™ has been a leading provider of healthcare business information to facilitate your healthcare prospecting and lead-generation campaigns. From the Hospital Blue Book® to the Billian's HealthDATA Portal, Billian's HealthDATA provides you with the healthcare decision makers, financial information and other pertinent facts that allow you to make better healthcare marketing decisions.