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Hospitals Agree the Medicare RAC Program Reduces Fraud and Errors, New IVANS Survey Shows

  (August 01, 2011)

Stamford, CT (PRWEB) August 01, 2011

IVANS, Inc., a national health information exchange, announced today that 73 percent of hospitals agree that the Recovery Audit Contractor (RAC) Program helps to reduce fraud and errors in the industry. However, more than 60 percent do not think the audit process is fair. According to IVANS 2011 RAC Audit Survey, respondents cited that the extra time and money it takes to substantiate a RAC claim is impacting budgets and resources that are already stretched too thin, and that the frequency (every 45 days) with which they can be audited is burdensome to their administrative workflow. The study also revealed that hospitals believe the review process is too subjective and they need education on how to reduce future audits.

IVANS survey demonstrates the need to ensure that these programs, which are valuable in their end results, are not too burdensome for providers, said Clare DeNicola, IVANS president and CEO. Using automation to streamline the workflow can help reduce the administrative challenges providers are facing with these audits.

Recognizing the need to provide a more efficient way to deliver medical records to the requesting contractor, CMS implemented the electronic submission of Medical Documentation (esMD) Program that enables Medicare auditors, including RACs, MACs, CERTs and PERMs, to accept electronic attachments from providers. Healthcare providers generally fax or send paper to substantiate Medicare audits today. Under the esMD Program, providers can work with a CMS-approved Health Information Handler (HIH), such as IVANS, which has developed a CONNECT-compatible gateway that conforms to Nationwide Health Information Network (NHIN) standards and leverages a web-based health information exchange (HIE) portal.

Beginning with Phase 1 of the esMD Program, providers can use IVANS LIME AuditDocs, to send documents in real-time instead of printing, packaging and shipping thousands of pages of medical documentation. This new solution provides detailed tracking so providers can monitor which documents have been sent and when they are received by the auditor. IVANS AuditDocs also includes document archiving to ensure documentation is readily available throughout the RAC appeals process. This feature can be especially useful since, according to CMS, Medicare providers won 64 percent of the claims appealed during a three year RAC demonstration.

In addition to using technology to send medical documentation electronically, providers are investing in automation and resources to help detect and eliminate improper payments before the arrival of a review audit contractor letter. The IVANS study found 32 percent of hospitals surveyed have put tracking software in place, 21 percent have hired additional staff or external resources to respond to RAC audits, and 38 percent have modified claims admission criteria to reduce future denials.

DeNicola said, Many of our customers are concerned with the time and financial impact required to meet the tight deadlines required by Medicare auditors for submitting medical documentation to support an audited claim. As Phase 1 of esMD gets underway, I am confident that providers will not only see benefits from a faster method for responding to payment audits, but the healthcare industry will embrace electronic submission of medical documentation as an important step toward advancing the adoption of interoperable health IT systems and health information exchanges across the country.

The survey was conducted electronically from June 7-22, 2011, and the results represent responses from 128 hospital providers across the United States.

Editors Note: For a full summary of IVANS 2011 RAC Audit Survey, contact Cecile Locurto at (203) 905-7330 or Cecile.Locurto(at)ivans(dot)com. For information about AuditDocs, visit

IVANS, Inc. provides a national administrative health information exchange for the healthcare industry, which includes hospitals, home health, skilled nursing, durable medical equipment suppliers, hospices and practitioners. Headquartered in Stamford, Conn. and a CMS approved vendor, IVANS has been serving over 1,000 insurance and healthcare payers, and 135,000 healthcare providers since 1983. For information, visit

Cecile M. Locurto


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