RAC plan & audit response


  • Print
  • Connect
  • Email
  • Facebook
  • Twitter
  • LinkedIn
  • Google+

The Centers for Medicare and Medicaid Services (CMS) is rolling out the Recovery Audit Contractor (RAC) program nationwide. As the program expands, Milliman can offer hospitals valuable insight on how best to prepare for, and minimize losses from, the RAC audits.

Our RAC expertise is derived from our decades of broad experience in healthcare management consulting. We are industry leaders in operational efficiency developing clinical guidelines and creating physician documentation improvement programs.

Milliman consultants provide a complete program to hospitals confronting RAC audits. We analyze current management procedures and identify areas for improvement, then implement and monitor new procedures designed to better address and prospectively minimize the risk of RAC audits. We create a comprehensive action plan and provide thorough education and training for hospital personnel.

We guide hospital staff including doctors, coders, and case managers, making sure procedures are consistent throughout the organization. We involve key hospital managers to bring needed buy-in for changes and to give staff the knowledge and infrastructure they require. Finally, we support the project with strong documentation templates and outcome measurement procedures to make sure new methods continue to be implemented consistently.

Proprietary tools yield precise results

Milliman's strong background in data and trend analysis is supported by our own advanced tools. Our Hospital Efficiency Index™ tool provides comprehensive benchmarking data that can help identify vulnerabilities in a hospital's procedures that could put it at risk for RAC-related Medicare payment reductions.

In addition, more than 1,000 healthcare clients across the United States are licensed users of our Milliman Care Guidelines®. Updated annually, these easy-to-use evidence-based clinical guidelines promote more informed and consistent clinical decisions, proactive care management and discharge planning and better management for complicated patients and extended stays.

Next steps