The Recovery Audit Contractors (RACs) provide a higher level of scrutiny for hospitals, physicians, and suppliers who submit claims to Medicare. The current areas of greatest vulnerability are incorrectly coded data, medically unnecessary admissions and services, and documentation not being sent to the RACs in a timely manner.

3M Health Information Systems has software and consulting services that can help facilitate compliant records, reducing the risk for audits as well as providing tools for rapid, accurate responses to record requests and assistance for effective appeals.

Prevention to Mitigate Risk

3M can help you in your process of creating compliant claims with software and consulting services that:

• Support accurate coding with tools that alert you to compliance issues before claims are submitted
• Identify potential target areas with a detailed, in-depth review of your hospital’s coded data and physician documentation
• Provide case managers with timely and valuable information
• Check for medical necessity before services are rendered
• Identify incorrect codes on outpatient claims

Response for Optimal Results

Hospitals can be prepared to respond quickly to auditors’ requests for records with our document management software that helps to:

• Track chart locations and the status of requests for information
• Respond faster with electronic records

Additionally, 3M can help you in determining areas of risk, which denials to appeal and your appeals process with software and consulting services that:

• Validate RAC audit findings
• Assist with the appeals process through tools that create an audit trail and document your decisions
• Manage the appeals process for you

Webinars

Preparing for Recovery Audit Contractors
Facilities around the country are preparing for the rollout of RACs in their states. Learn how two hospitals are preparing by implementing processes and technology to reduce their vulnerability and respond quickly to RAC requests.

During this recorded event you will learn how to:

• Reduce RAC audit vulnerability with accurate and compliant coding
• Track chart locations and status of requests for information
• Respond faster with electronic records

Date of presentation: May 1, 2008

3M™ Validation and Appeal Services for RAC - Help to prevent, detect, and mitigate RAC audit risk, as well as improve the performance of your facility. Services include RAC risk assessment a detailed, in-depth review of your hospital’s coded data and physician documentation related to inpatient and ambulatory services; validation of RAC audit findings and assistance with the appeal process; routine data monitoring of pre- and post-bill outpatient claims to identify risk and improve claim accuracy; and education and process change to improve physician documentation concurrent with improving the accuracy and integrity of clinical information.

3M™ Audit Expert System - 3M™ Audit Expert System (Inpatient) provides hospitals with 100 percent record review for coding compliance, providing immediate, consistent feedback to the coding staff.

3M™ Coding and Reimbursement System - Used by nearly 5,000 hospitals worldwide, this market-leading group of software products incorporates expert system technology to help coders evaluate and apply coding and grouping rules to individual patient records.

3M™ Ambulatory Revenue Management System/ ARMS with Medical Necessity Online - This software helps you manage your financial performance and minimize the financial risk of providing ambulatory care. Coders can edit for medical necessity (LCDs/NCDs), NCCI, and APC/OCE edits at the time of coding because the 3M Ambulatory Revenue Management Software is integrated with 3M’s medical necessity edit engine (the 3M™ Edit Engine).

3M™ APC Finder/APC Finder w/MN- 3M™ APCfinder™ Software enables coders to code, group, and estimate payment for individual outpatient records to help minimize errors and improve coding accuracy. As part of the 3M™ Coding and Reimbursement System, the software is routinely updated to meet changing regulatory standards. With a valuable add-on option, 3M APCfinder users can perform medical necessity validation during a coding session, while relying on regularly updated coding compliance content sets.

3M™ APC Oversight - APC Oversight assists your organization in grouping APCs, estimating costs and reimbursement, analyzing and reporting on outpatient claims data, and minimizing compliance risks. 3M consultants extract APC claims data from your billing system and assess critical areas in coding, charging, and billing that negatively impact reimbursement. 3M-defined reports graphically display areas for improving reimbursement, processes and compliance under the outpatient prospective payment system (OPPS).

3M™ Core Grouping Software - 3M Core Grouping Software is a computerized inpatient and outpatient record grouping, editing, and reimbursement system for providers, insurance companies, managed care companies, claims review companies, and other payers of hospital-submitted patient claims. The functions of the 3M Core Grouping Software are to assign patient records to inpatient or outpatient groups, evaluate the accuracy and completeness of clinical data, identify potential coding errors, and verify hospital claims for reimbursement.

3M™ DRG Assurance™ Program - The DRG Assurance Program supports an organization by improving documentation and coding to appropriately reflect patient acuity, resulting in accurate DRG assignment for CMS payment, accurate reflection of severity-of-illness and risk-of-mortality outcomes, and assistance in preparing for a severity-adjustment payment methodology.

3M™ Medical Necessity Online - 3M™ Medical Necessity Online enables hospitals and physician groups to validate Medicare coverage according to LCDs and NCDs before rendering services. It can be implemented into areas of your facility or to outreach clinics and physicians who do not have access to the dictionaries that your facility is currently using. With this application the customer is able to create, store, retrieve and print requisition forms and Advanced Beneficiary Notices (ABNs) with the capability to produce real-time reports to help track trends.

3M™ ChartRelease - Enables HIM departments to log and track requests for information, generate invoices, post payments for request fees, send action letters, and run multiple management and productivity reports resulting in increased HIM productivity.

3M™ ChartLocator - 3M ChartLocator Software automates how HIM departments streamline and manage the entire chart tracking process to for continued patient care, reimbursement, research, legal, and various ancillary activities.

3M™ ChartFact™ Software - 3M ChartFact Software is a chart completion management solution for hospitals and clinics. With ChartFact, users can quickly review both paper-based and/or electronic patient medical records within the same application that supports a transitional approach to an electronic medical record. ChartFact allows users to determine which components may be deficient, and then notify the appropriate providers of their incomplete records via hard-copy, fax or email.

3M™ ClinTrac™ Care Planning Manager - 3M ClinTrac Care Planning Manager Software integrates case management, social services, resource management and discharge planning to link an entire enterprise. It gives staff the ability to quickly identify issues that impact denial management and length of stay.