Ingenix Offerings Prepare Hospitals for Medicare Recovery Audit Contractor Program

Proactive software and consulting services enable hospitals to reduce risk for audit and simplify compliance with RAC audit processes

EDEN PRAIRIE, Minn. (April 06, 2009) –

Ingenix, a leader in health information solutions, has launched Ingenix RAC Manager and Ingenix Consulting RAC Support Services, a combination of Web-based applications and consulting services to help hospitals prepare for the Medicare Recovery Audit Contractor (RAC) program, which is rolling out nationally through January 1, 2010. These products and services save hospitals time and money by simplifying compliance with RAC standards and enabling hospitals to reduce audit risk by flagging cases likely to fall under RAC review.

The Medicare Modernization Act of 2003 established the RAC program, which began with a three-year pilot in five states (California, Florida, Massachusetts, New York and South Carolina). During the pilot, CMS uncovered more than $900 million in claim overpayments and $38 million in underpayments. CMS identified that 85 percent of overpayments uncovered during the pilot went to inpatient hospitals, making hospitals most likely to be audited as the CMS RAC program expands nationally.

Ingenix RAC Manager provides an early warning system of cases likely to trigger a RAC audit, so hospitals and their billing service partners can assess and amend the cases prior to claim submission. Delivered via Web-based software, RAC Manager includes built-in financial assessment tools to help hospitals identify potential risk areas and recommended actions to reduce risk of an audit.

Upon notification of an audit, RAC Manager will automatically track the case through the complete audit lifecycle from initial request to resolution and help health care providers determine if they should appeal or accept audit results. By supporting faster decisions, RAC Manager helps reduce administrative costs.

Smart software paired with proactive consulting

In addition to the Ingenix RAC Manager application, the company also offers RAC Support Services from Ingenix Consulting to help health care providers proactively design RAC program compliance into their operations. Ingenix Consulting RAC Support Services include:
Mock audits with third-party coding program evaluation
Shadow audits to identify audited cases most likely be appealed successfully
Assistance with the appeals process
Analytic reports on areas RAC audits typically target for overpayment recovery
Hands-on training for hospital management and coding staff
Clinical documentation and coding assessments to ensure complete and accurate reporting

Applying strategic council for retrospective cases enables health care providers to continually improve their systems and processes, reducing future risk and further contributing to better financial management.

“Ingenix offers hospitals with a proactive, strategic approach to preparing for the RAC program,” said Bill Miller, executive vice president, Health Care Delivery Solutions at Ingenix. “RAC Manager and our RAC Support Services deliver new strategies for reducing the risk of an audit and for lowering administrative costs associated with RAC compliance by identifying areas for improvement and enabling clients to take corrective action and simplify management of any audits.”

More information about Ingenix RAC Manager and Ingenix Consulting RAC Support Services is available at: www.ingenix.com/Products/Hospitals/RACSolutions.

About Ingenix Consulting

Ingenix Consulting, a data-driven organization in health and human services, employs more than 1,000 consultants with experience working with hospitals, physicians, health plans, employers, government agencies and pharmaceutical companies. Ingenix Consulting is a division of Ingenix. For more information, visit www.ingenixconsulting.com.

About Ingenix

Ingenix, a wholly owned subsidiary of UnitedHealth Group (NYSE: UNH), transforms organizations and improves health care through information and technology. Organizations rely on its innovative products, services and consulting to improve the delivery and operations of their business. More information about Ingenix can be obtained at www.ingenix.com.

Source: Ingenix