Manage and Appeal Recovery Audits
The Centers for Medicare and Medicaid Services (CMS) has certified InSight Audit to provide Electronic Submission of Medical Documentation (esMD) to Recovery Auditors, Medicare Administrative Contractors and other review contractors. The expansion of the esMD program to include electronic delivery of appeal letters, result letters, demand letters, and more is the future of audit tracking and InSight Audit is on the leading edge.
Growth in Recovery Audit Take-Backs
The dollars that Recovery Auditors are taking back from hospitals is growing at an unrelenting pace. Consider: In just the first two quarters of FY12, Medicare Recovery Auditor take-backs were more than they were for all of FY11. The encouraging news is that hospitals win 74% of the Recovery Audit cases they appeal.1 The discouraging news is that they appeal only 31% of those cases. When we ask hospitals why they don't appeal more cases, three-quarters of them tell us it's because they don't have the resources.
We've leveraged our RAC consulting experience and success into InSight Audit, the industry's premier RAC and medical claims audit software offering.
- Turn-key tracking and appeals for all medical claims audits, including RAC, CERT, ZPIC, MAC, MIC, OIG and other Commercial payor audits.
- Knowledgebase supplies winning appeal templates, strategies and case law.
- Designed from real-world RAC demonstration project experience.
- Streamlines workflow and stores all documentation by patient.
- Provides robust reports to analyze and trend areas of exposure and multi-level appeals.
- InSight Audit meets EHR's Platinum Certification and is AHA RACTrac Certified.
- See for yourself - Request a Demo.
RAC Consulting Services
Our team of experienced audit professionals have been helping hospitals to manage RAC audits since the early demonstration phase in 2006. Our client hospitals have consistently been able to appeal more incorrect overpayment determinations than the national average, as well as win more appeals than the national average.
Craneware offers RAC Appeal Services designed to get your organization out of the reactive guessing game of responding to appeals and into the proactive mode of establishing defensible policy and making Medicare's RAC auditors prove where you went wrong. We'll help you write the rule book instead of having it thrown at you.
1. American Hospital Association, RACTrac