RACTrac

1
RACTrac

• Presentation to AAIRNET
• May 20, 2008

2
Overview

• Quick Demo Wrap Up
• Permanent Program Improvements
• What is RACTrac? Our Goals
• Review of RACTrac Functionality
• What data will RACTrac Collect
• What data will be accessible for State, Regional
  and Metropolitan Associations
• Other Vendors
• National Roll Out and Timeline
• Top 5 Things to Share with Hospitals During RAC
  Education/Information Sessions
• Questions

3
ENDED MARCH 27!

• RAC Demonstration
• 2005 - 2008

4
Demo Wrap-up

• Contracts ended March 27
• Abrupt transition
• No further access to RACs
• FIs receiving RAC charts
• CMS and FIs fielding demo questions
• Demo evaluation expected in Mid-May 2008
• CMS to issue monthly reports until all demo
  business completed
• Permanent RACs to be named in Early June

5
History Demonstration ResultsTotal RAC
Collections for 3 years

• RACs collected 980 million, March 2005 March
  2008

Overpayments Collected by Provider Type
Overpayments Collected by Error Type
Outpatient Hosp/IRF/SNF 14
Other 17
Incorrectly Coded 35
DME 1
Physician/ Ambulance/ Lab/Other 1.5
No/Insufficient Documentation 8
Inpatient Hospital 84
Medically Unnecessary 40
SOURCE RAC Data Warehouse
6
History Demonstration ResultsClaim RACs
Appeals Data

• Provider Appeals of RAC-Initiated Overpayments
• Cumulative through 3/27/08 Claim RACs Only

Source RAC Data Warehouse and data reported by
Medicare claims processing contractors. Includes
both completed appeals and those currently
pending in the appeals process. These statistics
are based on appeals that were unknown to the
Medicare claims processing contractors on or
before 3/27/08. Any QIC or ALJ appeals reported
to the Medicare claims processing contractors
after that date are not included in these
statistics.
7
History Demonstration ResultsProgram Costs to
Date
2.7 RAC evaluation, validation and oversight
costs
4.3 Medicare claims processing contractor costs
93.0 RAC contingency fees

• Total Costs to Run RAC Demonstration 201.3 m
• March 2005 March 2008

8

• National RAC Program
• 2008 and Beyond

9
National RAC Program

• Tax Relief and Health Care Act of 2006
• Authorized national RAC program in 2008
• 3-phase rollout begins Spring 2008
• RACs announced in Early June (Post Evaluation
  Report Release)
• Spring/Summer RAC/CMS outreach
• Summer/Early Fall Audit activity starts

10
National Expansion Schedule
11
RAC Permanent Program Improvements

• Look-back reduced from 4 to 3 years
• Only claims dated 10-1-2007 or newer
• Medical director and certified coders required
• RAC Med Director to discuss denials upon request
• Contingency fees returned if denial reversed
• Starting July , 2008 No funds recouped for first
  2 levels of appeals process, if appeal filed
  within 40 days (Trans 314 and Transmittal 322)
• Some type of electronic tracking system by 2010

12
RAC Improvements (cont.)

• Medical Records limits
• Provider education tour before national rollout
• RAC accuracy to be validated annually
• Performance metrics for RACs reported publicly
• On-line provider survey on RAC performance
• Increased oversight of RAC target areas
• Process in place to re-bill ancillary costs
  (12x and 13x)

13
AHAs RAC Strategy

• Collaborate with state/metro/reg hospital assocs.
  on education and communication
• Help Hospitals prepare for RACs
• Work w CMS to achieve improvements
• Work with Congress on more fixes
• Collect data/examples to tell RAC story
• RACTrac

14
AHA RACTrac
15
RACTrac Goals

• Make it simple for hospitals to report data to
  AHA for use in advocacy activities
• Ensure data integrity and security
• Provide basic tools for internally tracking RAC
  activity
• Make data readily available for State, Regional,
  and Metropolitan and Hospital Associations to
  use for advocacy purposes
• Make data accessible to multi-hospital health
  systems
• Use data to educate the field about trends in RAC
  audit activity

16
What is RACTrac?

• Web-based online data collection application
  solicitation via email
• www.AHARACTrac.org (coming soon!)
• Quarterly data collection (open and close time
  period)
• Unit of analysis is the hospital i.e. ONE
  Medicare provider number per data entry
• Collect both quarterly snapshot and cumulative
  information on RAC experience to date

17
A Delicate Balancing Act.

• Challenge
• Need for information vs. data collection
  burden
• Risk
• If too complex, members wont use it, one size
  fits all approach is not appropriate at this time
• RACTrac is NOT a claim level data collection tool
  
• RACTrac provides a basic claim-level template
  that can be rolled up and uploaded into RACTrac
  should the hospital choose to utilize this
  feature
• RACTrac will not be able to count and aggregate
  individual claims

18
RACTrac Functionality
Internal Hospital System
Claim Level Guide
Summary Upload File
In order for hospitals to provide RACTrac with
summary level data on a quarterly basis, they
must have a mechanism to track activity
internally. RACTrac provides a BASIC claim level
template that will guide hospitals' in tracking
this data so that it can be prepared for upload
into RACTrac
Collect RAC Experience Data
Report RAC Experience
RAC Contact Database
AHA will release data at an aggregate level when
appropriate for advocacy purposes but will use
quarterly findings of some data for educational
purposes (e.g. what service areas or denial
reasons are RACs focused on this quarter.)
RACTracs primary purpose is the collection of
RAC experience data from hospitals on a quarterly
basis and to maintain it in a secure location.
.
Email Functionality
19
RACTrac will give us trends in RAC activity

• SEE ATTACHED SURVEY QUESTIONS
• Sample Talking Point
• 80 of hospitals experienced denials in their
  inpatient services in Quarter 1
• Hospitals cited medical necessity as their top
  reason for RAC denials in Quarter 1
• Total dollars reported to have been recouped by
  hospitals responding in RAC TRAC to date is XXX
  million or XXX per hospital.

20
Tools for State, Regional and Metro Association
Users
Hospital Status Report
RAC Experience Database
Aggregated Experience Report
Hospital Specific Experience Download
Data Use Agreement
.
RACTrac Registered User Will Report
Hospital Data
Regional/National RAC Reports (Issued by AHA and
Posted)
21
Data Available in Each Report
A CSV downloadable file with the current status
of hospitals within your state. Variables
included but not limited to, Registered User
Name, RAC Activity Y or N, Start date of
Activity, Reported data for current quarter Y or
N etc.
Hospital Status Report
Aggregated summary of the RAC experience activity
to of reporting hospitals in your state.
(Viewable and downloadable into CSV) See Attached
Summary Report DRAFT
Aggregated Experience Report
A CSV downloadable file of hospital specific RAC
experience data for reporting hospitals. This
data can be used for your own data analysis.
Hospital Specific Experience Download
When appropriate, AHA will aggregate data by RAC
Region and at the national level and release it
to the field for advocacy purposes. Additional
findings from the data will also be released for
educational purposes and posted to RACTrac when
appropriate. (e.g. Trends in reasons for
denials)
Regional/National RAC Reports (Issued by AHA and
Posted)
22
Other features at www.AHARACTrac.org

• Links toRAC websites and contact information
• CMS contact information, national and regional
  level contacts
• List of State, Regional and Metropolitan
  Association RAC Contacts and contact information
• RACTrac Updates
• Link to www.aha.org RAC site
• Contact information for RACTrac Help Desk
• A third party will manage the data collection
  and day to day questions for AHA
• BAH will maintain technical help desk

23
Vendors in the Marketplace

• Price Waterhouse Coopers Developed web based
  claim level tool for hospitals in Florida and
  will begin to market to state hospital
  associations soon
• Intersect Healthcare Veracity, a web based
  claim level tool for hospitals
• ERehab Data and UDS both have claim level appeals
  tracking modules for inpatient rehabilitation
  facilities
• Both PWC and Intersect have agreed work with AHA
  to ensure that data captured in their tools can
  easily be shared in RACTrac
• AHA is willing to work with vendors who would
  like to make their tools RACTrac compliant.

24
National Rollout and Timeline

• Estimated national release of RACTrac is
  currently scheduled for late June 2008
• RACTrac Member Advisory
• AHA News and News Now
• Letters and Emails to all CEOs Following Member
  Advisory with Security Codes for Registering in
  RACTrac
• RACTrac Webinar Series
• State, Regional and Metropolitan Associations
  will be notified prior to release to the field
  and materials will be shared
• Ongoing communications promoting RACTrac
  registration in the first 20 states.
• Data collection to officially begin - TBD

25
Top 5 (or 6) Things to Share with Your Members re
RACTrac

• Internally tracking RAC audit activity is
  essential for minimizing financial risk,
  identifying areas for improvement and surviving
  the RACs
• Data on the impact of the RACs on hospitals is
  essential for a successful advocacy effort.
• Participation in RACTrac will provide AHA and the
  State Association the data they need to advocate
  on your behalf.
• Participation in RACTrac will allow AHA to
  identify trends in reasons for denials across the
  RAC regions or at the national level. This
  information can be used to educate the field.
• RACTrac provides a basic tool to organize your
  data
• Ask the vendor Will you make your claim level
  tool RACTrac compliant?

26
Checklist for State, Regional and Metropolitan
Associations

• Encourage participation in RACTrac - the more
  hospitals that report, the richer the data we
  will have for educational and advocacy purposes
• Mention National Rollout of RACTrac in
  newsletters and RAC communications with members
• Add a slide in all RAC Presentations about
  RACTrac.
• Advertise National Webinars after national
  release Schedule one of your own! (Train the
  trainer documents coming soon!)
• When appropriate, use your state level data in
  your advocacy efforts.
• Encourage hospitals to ask their vendors to make
  their tools RACTrac compliant

27
QUESTIONS

• RACTrac Questions
• Alyssa Keefe, AHA
• akeefe_at_aha.org or 202-626-2294
• General RAC Questions
• RACInfo_at_aha.org