With the national rollout of Medicare’s Recovery Audit Contractor (RA) program in 2010, hospitals across the country were in critical need of a solution to manage their audit processes and protect revenue—and this multi-facility health system was no different. The Recovery Audit Program’s mission is to identify and correct Medicare improper payments and implement actions to prevent future improper payments for health care services provided to Medicare beneficiaries. In anticipation of the program, the client established a Health Information Management (HIM) corporate RAC department to manage its audit support activities. At the onset of the program, the team was effectively managing its low volume of cases through manual processes and a number of disparate systems. But as the RA program quickly gained momentum, so did the challenges facing the team. Within a few years, the client was looking for a comprehensive, integrated solution that would enable them to enhance quality and data integrity; increase capacity; and work seamlessly across internal functions and with external partners. This new solution needed to not only address the increase in Medicare audits but also audits from Medicaid and Commercial Insurance Carriers.
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