UHC's Clinical Documentation Audit Profile assists hospitals with RAC reviews

Sep 18 2009

University HealthSystem Consortium (UHC) has announced the development of the Clinical Documentation Audit Profile, designed to assist hospitals with Recovery Audit Contractor (RAC) reviews. The tool is available to member academic medical centers through UHC's unique Clinical Data Base/Resource Manager(TM). The Clinical Documentation Audit Profile will help hospitals ensure that submitted claims meet Medicare rules.

In response to the Tax Relief and Health Care Act of 2006, in which Congress required a permanent, national RAC program to be in place by January 1, 2010, UHC is offering this helpful resource to UHC Clinical Data Base/Resource Manager(TM) (CDB/RM) participants. The new Clinical Documentation Audit Profile is intended to be a companion to the UHC Coding Profile.

Identifying improper payments (over- or underpayments) made on claims of health care services provided to Medicare beneficiaries is instrumental to keeping health care costs in check. In fact, the RAC program is being phased in nationally after a 3-year demonstration project identified more than $1 billion in improper Medicare payments, according to the Centers for Medicare & Medicaid Services (CMS).

"With this new tool, members can identify any patterns of denied claims within their own practices or facilities, streamlining operations and finance," said Steve Meurer, PhD, vice president of UHC's Clinical Data & Informatics department. "This report has been designed to meet the needs of members as they prepare for RAC reviews."

With this new UHC offering, participants will be better able to meet the goals of the RAC program, such as avoiding submission of claims that do not comply with Medicare rules, lowering the CMS error rate, and protecting taxpayers and future Medicare beneficiaries from excessive payments.