The OnBase RAC Administration Solution

Helping organizations manage the Recovery Audit Contractor (RAC) appeal process

What is a Medicare RAC Audit?

• RAC = Recovery Audit Contractor

• Organizations impacted – bill for Medicare Parts A&B

• Find and correct improper payments under the Medicare Fee For Service program– Coding errors– Duplicate charges– Medical necessity

Goal = Protect the Medicare Trust Fund Prevent fraud, abuse and waste

RAC Audit Timeline

• RAC Demonstration Project

Pilot project designed to see if RACs would be a cost effective way to recover incorrect payments to providers

• Spring 2005 – March 27, 2008

• States audited: New York, Massachusetts, Florida, California, Arizona and South Carolina

• Spring 2008 – 4 permanent RACs selected – CGI Technologies and Solutions, Inc.

– Connolly Consulting Associates, Inc.  

– Diversified Collection Services, Inc.

– HealthDataInsights, Inc.

Impact on Hospitals/Providers…

Results from the 3 year demonstration program (included 6 states):

• $992.7 million in Overpayments collected

• $37.8 million in Underpayments identified

• $46 million Overturned on Appeal

• $215.3 million Program Cost

NET =

$693.6 million returned to Medicare Trust Fund

Types of RAC Reviews

• Automated– National Claims History Files software utilized (Data Mining)– Identified certain overpayments

• Service not covered• Incorrect coding• Duplicate procedure

• Complex– Claims History Files– Suspicious for overpayments– Copies of medical records requested and reviewed

Schedule

Implementation nationwide January 1, 2010

OnBase RAC Solution• Designed to manage the provider’s appeal process to the RAC

auditor and the denial of medical claims– Task Management

• Track responsible employee assigned to each task– Configurable Parameters– Tracking functionality

• Shipping information• Expected completion dates / appeal timelines• Medical record request costs• Interest due on recovered funds• Communication with RAC personnel

– Upload Claim History

• Dashboard Views:– Administration/Management– Financial – Risk Analysis– Process Improvement

Software Technology Firm established in 1991

Privately-held, 65% by family and employees

Over 900 employees

More than 9,000 Clients

OnBase®

Enterprise Content Management (ECM) Software

Serviced through a combination of channel partners & Hyland direct

Hyland Software Inc. Software Inc.

Exclusive endorsement from the American Hospital Association (AHA) for its Integrated Document Management system

OnBase RAC Administration Solution = RACTrac Compatible Vendor

On a Scale of 1 – 9 - Worth the effort:  8.08Would you buy it again? 

100% customer satisfaction

Industry Recognition

ACE Award for Best Document Management Application in Healthcare

Comprehensive, Integrated Modular Solution

Highest Level of Configurability

Ease of Integration

Open, Secure & Scalable Architecture

Quicker & Realistic Deployment Times

Lower Cost of Ownership

Award-Winning Implementation Methodologies

Healthcare Specific Modules and Expertise

The OnBase Difference

OnBase RAC Solution – Additional Information

http://www.Hyland.com

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