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Coordinated system response to RAC

Ministry Health Care is a multi-hospital system operating in the northern reaches of Wisconsin.  The medical and nurse directors of Ministry’s RAC team have outlined the development and coordination of a system-level approach to managing and responding to RAC audits. 

The RAC team is both multi-disciplinary, including physicians, nurses, case managers, risk managers, IT specialists, etc., and system-wide, with members drawn from many of the system’s hospitals, clinics, and other provider sites.  The role of a system RAC medical director is delineated, as are the benefits of using a centralized approach to handling audits and appeals. 

Challenges met included:

  • uncertainty of what to anticipate as RAC regulations were being developed
  • coordination of meetings and ongoing communication between team members located at different sites
  • working with EHR systems that covered everything from completely paper-based to totally paperless
  • developing a centralized knowledge repository for team work product (meeting minutes, documents) and continuing education material

Ministry’s RAC approach has been so successful that the team now coordinates the audit and appeal process for a smaller hospital system in which Ministry has an ownership interest.  They have also launched a listserv, RAC Relief, as a means of sharing their experiences and learning from others.  Contact larry.hegland@ministryhealth.org to request participation.

Source: Hegland, Larry, and Tullbane, Cynthia.  Responding to the recovery audit contractor program: a system-wide approach.  Physician Executive.  37(3):44-49, May-June 2011.

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