I lived for nine years in the city of Philadelphia. At a certain point, when you are an urban dweller, all the sirens, traffic and distant midnight rumbles of metal trash can lids become a sort of urban symphony. After a while, the constant passing of cars, with a little imagination, becomes like the waves of the ocean. My wife, in contrast, is from a town of 1,100 on the Illinois / Wisconsin border. I once stayed over night in that town, and it was too quiet. An owl hooted outside the window, and I immediately thought we were under attack from nature, much like the less-than-classic 1970’s film Day Of The Animals.
I don’t trust quiet. Noiseless environments invite startling clatter by their very existence. The question I get more than any other is “When do you think the RACs will start auditing physicians?”. Aside from some scattered issues here and there, individual doctors have been spared RAC wrath. It was with these thoughts in mind that I reviewed the the RAC issues lists this morning (desperate for a topic, to be brutally honest), and found that three of the four contractors have been slow to add approved issues of late.
The one exception to the silence is DCS Healthcare, the Region A RAC, which has spent the last month slowly expanding the number of medical necessity issues listed for inpatient hospitals. This comes on the heels of nearly reaching the end of the list of DRGs to validate.
Being one who distrusts quiet, I decided to dig deeper. In a world where RAC contractors must have their own websites, this isn’t as hard as one might think. I began with a basic question; are they hiring?
I went in alphabetical order, starting with CGI, the Region B RAC. What stood out about CGI’s list is that of the 13 auditing positions currently open with the company, four are for nurse auditors. Given that CGI currently has one of the worst auditing success rates of the contractors, according to the latest AHA RACTrac survey, it doesn’t surprise me that any expansion of their workforce would include people with direct clinical experience. The remainder of their careers list provided no insight into future targets.
Next up was Connolly, the Region C RAC. While there were over a dozen positions for healthcare auditors, one particular listing, for a Medicaid investigator, stood out, as Connolly has yet to announce that they have been contracted by any state to be a Medicaid RAC contractor. Stay tuned on this front.
Finally, I took a look at HDI, the Region D RAC. It has been nearly seven weeks since HDI added a new issue to their website listing. In looking at their open positions listing, it was easy to see why. HDI is currently in need of a medical director, provider services director, coding validation director and client implementation director. With such a seeming vacuum at the top of their company structure, it may be some time before a new issue is added to their list.
The second most common question I receive with regard to RAC contractors is “Do you have any idea how many people the RACs employ to look at claims?”. After doing a little searching this morning, I can tell you that while I can’t put a definitive number to that question, assume that the number you have in mind will continue to grow. With contingency fees come incentives to look at as many issues as is humanly possible. The only element missing is to find humans to fill the silence.