Streamline Claims Audits: RAC, MIC, CERT, MAC and ZPIC

InSight Audit^®

Are you ready for RAC, MIC, CERT, MAC and ZPIC audits? The Medicare Recovery Audit Program (previously the RAC program) is growing at an unrelenting pace, taking backing hundreds of millions of dollars in previously approved and paid Medicare payments. Now is the time to establish your audit strategy with InSight Audit:

• Appeal more cases with current staff levels.
• Weigh likely outcomes and calculate appropriate dollar amounts for reserves.
• Draw on a constantly updated knowledge base of successful appeals and templated content that has won RAC appeals to the ALJ level.
• List summaries of all EOBs, with immediate access to any of them.
• Electronic submission of medical documentation (esMD) to Recovery Auditors and contractors
• Backed with AHA RACTrac certification and fully compliant with HIPAA technical security and privacy provisions.

Designed for Audit Success

InSight Audit is a web-based tool for creating a core audit tracking and correspondence database to minimize exposure and give your hospital the best chance of appealing audit denials. It marries easy-to-use data entry tools with workflow and reporting capabilities designed specifically for navigating multiple levels of inquiries and appeals. Securely accessed from any browser, InSight Audit provides intuitive views of all entries, tracking audited claims from chart request all the way to federal district court appeal.

InSight Audit can be integrated with the full 835 interface engine included with InSight Denials. This provides automated access to audit-related remittance data, including the N432 Remittance Advice Remark Code that monitors payment adjustment information from audits.

Manage Workflow Across Multiple Departments and Locations

InSight Audit features a comprehensive workflow tool that distributes required tasks across multiple team members, departments, and facilities as needed, updating the status of all components in the central patient record as it moves through each stage. Integrated reporting tools make it easy to track each element of the process and ensure individual accountability at every step in the workflow.

Users can upload and attach all documentation associated with each appeal, such as denial letters, appeal letters, and decision letters. InSight Audit automatically compiles a complete history for each appeal, encompassing the full communication trail.

Reporting

InSight Audit integrates with InSight Reports to enable staff to quickly identify and trend areas of exposure and multi-level appeals. Reporting capabilities include the ability to calculate all applicable due dates and to create shared reports and team alerts for key deadlines. InSight Audit is American Hospital Association RACTrac-certified and can generate a wide range of status reports, including information on:

• denial reasons
• retractions
• DRG/CPT
• executive summaries
• appeal levels
• outcomes
• risk
• workflow productivity
• enterprise reporting

Knowledgebase

InSight Audit leverages a fully web-based platform that is constantly updated to include the latest information on best practices and payment rules, the result of continuous work by Craneware’s RAC consultants. The content set within that large and growing knowledgebase includes:

• correspondence templates
• complete record checklist
• relevant forms
• references for winning arguments:
  • Medicare regulations
  • Social Security Act
  • prior precedent in overturned appeals

RAC Appeal Services

Clients who engage Craneware's RAC Appeal Consulting are able to appeal more cases and win more appeals than the national average as reported by the American Hospital Association's RACTrac survey and CMS. The service enables clients to protect more money from Recovery Auditor take-back attempts, and without adding staff or staff hours.