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Medicare RAC Audits Software Solution

Medicare is taking aggressive steps to enforce evidence-based coverage policies and curb potential. The Medicare Recovery Audit Contractor (RAC) program goes beyond the traditional Medicare PSC audits, Medicare ZPIC audits and Medicaid Integrity Contractor audits and represents a significant and immediate financial risk for any healthcare provider. Given the complex process for appeals and stringent penalty clauses, healthcare providers should prepare themselves to handle the entire Medicare RAC audit process from a position of strength and confidence.

MetricStream offers an integrated solution for meeting the challenges of RAC audits - from fulfilling the initial information and record requests, to timely submissions, determinations and appeals. The solution makes access to detailed information easy and quick with the ability to track all key tasks, information flows and critical dates. The system ensures that various department can collaborate under a common framework and approach for regulatory compliance and risk management. With MetricStream, healthcare organizations can take charge of the RAC audit process to mitigate the risk of losing legitimate earnings.

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MetricStream Medicare RAC Audits Software Solution

MetricStream offers comprehensive solutions that not only automate, streamline and integrate the preparation for RAC audits, but also promote a more proactive approach. Advanced capabilities such as built-in status tracking and reporting, integrated document management, remediation action workflows and auto generation of letters allow organizations to implement industry best practices for regular self-assessments and internal audits. Organizations are empowered to stay ahead of RAC audit requirements, while mitigating the risk of losing legitimate earnings. Healthcare providers can proactively develop strategies to engage with RAC auditors by demonstrating a high degree of compliance with regular self assessments and efficient internal audits.

Powerful reporting capabilities allows aggregating data and generating reports that show trends based on a wide range of variables, including type of service or service area, the physician or other provider associated with the service being audited, and diagnosis codes. By tracking the audit patterns, the solution enables hospital management to focus its efforts on the areas that need attention based on their compliance status with Medicare regulations guidelines. In addition to streamlining RAC audits, the solution provides the flexibility to support all types of Medicare and Medicaid related medical claims audits including MIC, PSC, CERT, MFCU and others using configurable workflows and templates.

Incorporating RAC audit management into the organization's overall compliance and risk management strategy also enables development of a mature governance environment to satisfy boards of directors and investors.

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