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Discussion 2 responses

When responding to your classmates, recommend collaborative techniques that might contribute to their audit preparations. Provide specific examples to support your response.

Post #1 

Preparing for any audit can cause an organization to instantly be on the defensive or feel as if they have done something wrong. The first thing I would do as a healthcare leader would be to emphasize to those affected that they are not trying to get anyone in trouble or there needs to be a shift in blame. I would reiterate that this is being done to improve future quality and to ensure that the organization is billing correctly. This compliance is very important for the sustainability of a health organization and an audit proves (or disproves) that this aspect of the care is being done correctly. 

Another preparation method would be having all potential document requests already prepared. The timeliness of these submissions will make speed up the process and help the auditors to do their jobs easier. CMS says RACs can make patient-status judgments going back six months as long as hospitals have submitted their claims within 3 months of patient treatment (Stein, 2015). Having this information going back in the allotted time frame will be important for quick retrieval of these documents. 

Collaboration is crucial if this process is going to occur with the least amount of resistance. Having all providers educated to the process and why this is occurring will be important so they will assist with maximum compliance. Collaborating and communicating with the provider groups is important because I have found in my own experience that people will push back on these sorts of processes when they do not fully understand why it is occurring. That is why educating all parties involved with this audit will be such an important part of this process. A hospital administrator has the resources and network to provide and promote this education and ultimately improve the healthcare facilities billing and coding quality.  

Stein Michelle M. (2015). CMS Limits RAC Audits On Hospital Status Reviews. Inside CMS18(1), 19.

Post #2

The Recovery Audit Program identifies overpayments or underpayments on claims for services under Medicare (Castro, 2018). The Recovery Audit Contractors (RAC) carry out the actions for the audits of the program in their assigned regions of the United States (Castro, 2018). 

As a healthcare administrator in a hospital environment I would want everyone to have knowledge of the audit process and any concerns, but I believe that having a designated staff member, or team, who can best prepare the organization is key. Having a team, or team member, who can create a compliance plan and be familiar with the audit process would be beneficial. I would utilize information from the RAC to gain insight on how to anticipate what will be expected by the RAC. For example, the RAC quarterly newsletters that identify their top concerns can help identify what should be a top focus for your organization when reviewing processes and corrective action that may be necessary (Castro, 2018). The RAC also works to ensure that their policies are understood clearly to ensure standardization and prevent various interpretations (Castro, 2018). The team would ideally have an understanding of how to utilize the RAC web portal for communication, which can make the process more efficient and effective. Ideally, they would be able to obtain and provide any requested information quickly when the need occurs. Learning from other audits to prevent future audits would be a goal. Reviewing past claims in audits and possible causes can give an idea of what training or strategies should be implemented to prevent future errors (Stillwell, 2018). 


Castro, A.B. (2018). Principles of healthcare reimbursement (6th ed.). Chicago, IL: American Health Information Management Association.

Stillwell, K. (2018, January 5). Be Prepared for a Recovery Audit Contractor Audit. Retrieved from https://www.thedoctors.com/articles/avoid-being-put-on-the-rac-be-prepared-for-a-recovery-audit-contractor-audit/


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