RAC Guard™ - Feature Specification List
Looking for a Turnkey Data Mining Tool for RAC? We have it!
All we need is your hospital’s historical 837 claims files and all you need is a web browser!
Wellington has developed a comprehensive RAC Issue editing and reporting system.
Our RAC Guard Preventative Editing and Monitoring system is web based, so startup time is minimal. Training can be performed remotely, saving you time and money.
The RAC Guard Preventative Editing and Monitoring system uses three levels of analysis to help you identify claims that have potential RAC exposure.
- Level One is the RAC Issue – Wellington identifies the claims that meet the issues published by the RAC. As new issues are published, Wellington makes them available within the tool.
- Level Two is Vulnerability – The simple fact is the issues published on RAC’s website are not sufficiently detailed to identify potential claims that are likely to be targeted by the RAC. Wellington has developed detailed edits that help you identify why one claim within an issue may be more likely to be selected than another. These vulnerability edits are comprehensive and help to refine and focus your research and auditing efforts.
- Level Three is the Comprehensive Claim Risk - While the Level Two Vulnerability Edits detail what may be of further concern, the Comprehensive Claim Risk helps to grade the claim, taking into consideration not only the RAC Issue and Vulnerability Edits, but also the financial aspects of the claim and potential total payback.
The results of all of this editing are recorded in online reports that allow you to start at summary levels and drill down to the claim detail level. Using this information allows you to effectively focus investigations, audits and training.
The RAC Guard Preventative Editing and Monitoring system allows you to “slice and dice” the information in various ways including breaking it down by attending physician. Estimated paybacks are calculated for each vulnerable claim based on your hospital’s DRG and APC reimbursement profile. Report information can be saved in PDF or Excel formats.
RAC Guard issues and vulnerability edits can be turned off and on at anytime, even if the RAC is from another region.
Wellington’s RAC Guard Preventative Editing and Monitoring system also offers comparison reporting so that you can see how you compare to other hospitals within your state.
Don’t have historical claims? We probably have your redacted Medpar information that can be used.