Recovery Audit Contractor (RAC) Readiness Assessment

Beginning January 1, 2009 RAC auditors are scheduled to begin auditing providers across the United States.  As an initial step for all healthcare providers, we recommend understanding the extent of your RAC exposure.   Specifically, Sunstone’s “RAC Population Data Analysis” is a simple and cost-effective way to determine your exposure and the number of claims at potential risk.

Our proprietary software tools assist providers with identifying claims that may have potential risk, according to each specific RAC issue.  Our “RAC Population Data Analysis” combines a review of both the known RAC issues as well as other potential compliance issues that we’ve discovered while assisting our clients.  This data-driven analysis informs providers about their claims population and corresponding financial exposure for each RAC issue. 

 Our software processes both inpatient and outpatient data to identify all claims that have a potential RAC issue, categorized as: 

ü        Automated Claims 

ü        Complex Reviews 

ü        Utilization Management 

Following our analysis, we will report the total number of claims by RAC issue, the corresponding payments for each, along with the detailed information for all claims.  This will help determine the specific samples for medical record and claims analyses. Following this initial review we can provide additional RAC assessment services as needed.

 For more information about Sunstone’s RAC solutions, please contact Greg St. Clair at 717-652-1422 or via email at gregstclair@sunstoneconsulting.com.