Ask the care expert: If we have an RAC audit, can we also get an additional review from it?

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Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Q: I am a new nurse administrator and just heard that if we have a RAC audit, we can also get an additional review from this audit. Is that true?

A: The answer is yes. If your facility receives a request from your Recovery Audit Contractor (RAC) for more information, this is called an ADR (additional documentation request). While I know your first response may be sheer panic, take a deep breath and just be sure you have all of your information in order.

If the documents are perceived as sloppy and reviewers need to look through “dog-eared” pages, perception becomes reality. Highlighting documentation that supports your claim is often good to do.

Implement an internal tracking system so you are able to track requests for records or completed documentation. Know when you sent this information. Keep copies of all documents. If you have had many denials, it is important to keep all of this information organized and sent prior to its due date. If you have requested records and you miss a 45-day time limit, you may get automatic denials.

If you need an extension for a record request, you need to email or write your RAC to request this. Use a traceable means, such as certified mail.

Make sure the RAC is permitted to request that particular record. If the RAC has exceeded the record request limit, the SNF has the right to decline submission. Keep track in your facility of the number of records your RAC has requested from you in a 45-day period. (In 2010, CMS revisited the ADR limits.)

There is software sold to keep track of the RAC requests, dates due, etc., but Excel forms set up to meet your facility's needs work well, too. Do what works best for you. But no matter what, track the day the request arrives, and follow it until the request is returned. Don't allow documents to sit in a corner.