Bellin Health Systems and Baystate Health Drive Unexpected Gains Through RAC Preparation Activities

WASHINGTON, Aug. 5 /PRNewswire-FirstCall/ -- Most hospital revenue cycle leaders have established protocols for responding to Revenue Audit Contractors (RACs), as well as post-payment audits targeting Medicaid and commercial claims.  Mindful of the dollars at stake, these leaders have employed a number of technology and process-related improvements to mitigate risk and solidify overall revenue integrity.

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After researching post-payment audit responses at hundreds of healthcare providers across all four RAC regions for the past 18 months, The Advisory Board Company's research suggests that best practice hospitals have derived an unexpected benefit from their increased scrutiny of claims and clinical documentation: these hospitals have located favorable opportunities for revenue generation.

"In their response to the first RAC and MIC (Medicaid Integrity Contractors) audits, hospitals focused largely on overpayments and have made solid progress in addressing underlying coding and documentation underperformance, as well as other root causes that drive increased audit risk," said Zachary Stillerman, Managing Director of The Advisory Board Company's Revenue Cycle Services. Stillerman oversees Revenue Integrity Compass, which provides solutions for hospitals' challenges stemming from payer-based audits and appeals.  "What we have observed as of late, is that a small group of providers are using this renewed focus on revenue integrity to identify underpayments, as well."

In essence, Stillerman noted, these providers are finding an unexpected positive outcome from the audit experience, adding, "These providers have recognized that revenue integrity can work both ways and have begun to use analytics to pinpoint areas of underpayment.  The result, in several cases we have studied, is the recovery of significant dollars."

One organization that has surfaced such revenue opportunities is Bellin Health Systems of Green Bay, Wisconsin, a member of the Revenue Integrity Compass cohort since 2009.  "Hospitals must have both a mechanism and strategy to focus on the right risk areas in an efficient and effective manner," said Bellin's Revenue Audit Coordinator, Karen Sagen.

"We use the Revenue Integrity Compass platform to pinpoint threats of overpayment and capture revenue by finding underpayments," Sagen added, "freeing us to think more broadly about revenue integrity, and spend more time enhancing physician documentation and clinical coding."

According to Sagen, Bellin Health has recovered approximately $300,000 in underpayments in the past six months.

Baystate Health of Springfield, Massachusetts, also a member of the Revenue Integrity Compass cohort since 2009, offers another example of current best practice.  "One lesson learned from the demonstration project is that if anyone thought they could run their approach to RACs on an Excel sheet, they can't," said Susana Hall, Baystate's Clinical Business Consultant for Managed Care and Director, Post Acute Services. "Revenue cycle leadership means thinking broadly about revenue integrity.  Institutionally, every area involved in the revenue cycle, including clinical and financial personnel, is proactively working to reduce risk and also looking for ways to increase [revenue] capture through the identification of underpayments."

Bellin Health and Baystate Health have joined a cohort of more than 200 hospitals and health systems exchanging best practices and experiences relating to RAC audits and appeals through The Advisory Board Company's Revenue Integrity Compass.  Other cohort members include:

• Bayhealth (Dover and Milford, Delaware);
• Summa Health System (Akron, Ohio); and
• Overlake Hospital Medical Center (Seattle, Washington)

Members of the Revenue Integrity Compass cohort will convene in Washington, D.C. on August 10 to exchange best practices at a User Summit.  

To learn more about how best-practice hospitals are capitalizing on the new era of post-payment audit to reduce risk and increase revenue opportunities, please visit http://www.advisory.com/public/rac/.

About Revenue Integrity Compass

The Advisory Board Company's Revenue Integrity Compass includes thorough market research and best-in-class technology to address dynamic challenges faced by hospital revenue integrity teams.  The Revenue Integrity Compass technology goes beyond audit compliance to reduce risk at the source and generate revenue through proactive engagement. Please visit http://www.advisory.com/public/rac/ to learn how Revenue Integrity Compass can help you proactively manage the RAC process, minimize audit risk and capture untapped revenues.

About Baystate Health

Based in Springfield, Massachusetts, Baystate Health is an integrated health care system that includes three hospitals, outpatient facilities, home care hospice services and other services. Baystate Medical Center is the largest of the hospitals in the Baystate Health system, and it is the academic teaching hospital that serves as the western campus of Tufts University School of Medicine. U.S. News & World Report named Baystate Medical Center one of America's Best Hospitals for 2008.  To learn more visit www.baystatehealth.org.

About Bellin Health Systems

Bellin Health is an integrated health care delivery system based in Green Bay.  It has serviced people in Northeast Wisconsin and Michigan's Upper Peninsula since 1908.  It is comprised of Bellin Hospital, Bellin Psychiatric Center, 25 Bellin Health Family Medical Center primary care physician clinics, and several retail health clinics known as Bellin Health FastCare.  Bellin also operates Bellin Health Partners, a physician-hospital organization with 230 specialty physician members, the Oconto Hospital & Medical Center, a critical access hospital in Oconto, Bellin Fitness Center with four locations, Bel-Regional, a provider of home medical equipment and supplies, and Bellin College.  With its 2,800 employees, Bellin Health is known for its emphasis on preventive health care and is the region's leader in cardiac, orthopedics, sports medicine, digestive health, mental health, and primary care medicine.  Bellin has been recognized several times by leading quality benchmark organizations.  To learn more visit www.bellin.org.

About The Advisory Board Company

The Advisory Board Company is a leading provider of comprehensive performance improvement services to the health care, health benefits and education sectors – including operational best practices and insights, technology solutions, leadership development, and consulting and management support.  Drawing on nearly three decades of experience, The Advisory Board Company is privileged to serve a membership of more than 2,800 organizations, all sharing a charter "above commerce," a commitment to best-practice standards, and an unyielding insistence on continual improvement.  For more information visit http://www.advisoryboardcompany.com.

SOURCE The Advisory Board Company