Florida Hospital is an Orlando-based health system comprised of 18 campuses in Central Florida. In this Q&A interview, Susan Bihler BS, RN, LHRM, LNCC, Director of Utilization Management, discusses the system's approach to RAC.
Who is on your RAC team?
Our RAC Team is made up of:
- The Senior Vice President of Revenue Management
- The Administrative Director of Patient Financial Services,
- The Director of Government Payers/Cash Processing/Document Support
- The HIM Director
- The Coding Department Director
- The Medical Director
- The Director of Utilization Management
- Representatives from all of the departments
- Compliance.
When did you build it?
This team was in place as part of our Denials Management Process even before RAC began, and we just streamlined it to better meet the specific needs of RAC once the demonstration project began in March 2005.
Who leads the team?
Ultimately the leader is our Senior Vice President. However, the Director of Government Payers/Cash Processing/Document Support has a very big role in the overall RAC process on a day-to-day basis and answers directly to the Senior Vice President.
How often do you meet?
We have a standing monthly meeting.
What are some of the process changes that have resulted from the RAC team?
As time went on, our processes obviously became more streamlined and more time effective. We have become more automated in our processes with the development of computerized data management and tracking/trending tools.
What advice would you offer to other organizations on building RAC teams?
Make a strong team that is composed of representatives of:
- Executive Leadership
- Revenue Leadership
- Patient Financial Services
- Compliance
- HIM/Coding
- Utilization Management
- Denial Management
- The Medical Director.
Also, have frequent dialogs regarding your processes. Always be open to change, as this RAC process is not stagnant. A planned proactive approach is the key to success.
Publication Date: Tuesday, September 29, 2009