What are RAC audits looking for?

What are RAC audits looking for?

They look for improper payments The aim of the Medicare Fee for Service Recovery Audit Program is to identify and fix incorrect and improper payments in a variety of healthcare fields, home health and hospice included. RAC looks for both overpayments made to patients and underpayments made to providers.

What is a CMS RAC audit?

What does a Recovery Audit Contractor (RAC) do? RAC’s review claims on a post-payment basis. The RAC’s detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.

How far back can CMS audit?

Recovery Auditors who choose to review a provider using their 0.5% baseline annual ADR limit may review under a 3-year look-back period, per CMS approval.

Why do CMS and RAC auditors have the right to access your medical records?

RAC auditors will usually request medical records to complete the audit. For example, they may request medical records that detail a more complex procedure to ensure you were paid correctly for the services you provided.

What is RAC in healthcare?

RAC is an acronym for recovery audit contractor. RAC represents an effort to audit health care providers on behalf of Medicare and Medicaid in order to identify improper payments made on claims of health care services provided to Medicare beneficiaries.

How do I prepare for a RAC audit?

Here are five ways you can prepare.

  1. Perform an Internal Audit. This action will help you to determine the likelihood of coding and billing mistakes within your company.
  2. Identify and Correct Coding/Billing Issues.
  3. Review Problem Areas.
  4. Check Documentation.
  5. Find Assistance.

Who audits RAC?

Q: Who is subject to a RAC audit? The Centers for Medicare and Medicaid Services (CMS) contracts with private companies who conduct RAC audits. There is one RAC auditor award per RAC region and each audit contractor is a full-service firm, not one person.

When did RAC audits start?

Part D RAC Program History In 2005, CMS implemented the Medicare Recovery Audit Contractor (RAC) Program as a demonstration program for Medicare fee-for-service (FFS); Medicare Parts A and Part B. The pilot program successfully corrected more than $1.03 Billion in Medicare improper payments.

Are RACs effective?

Contingency Fees Based on Denial Overturn Rates For starters, RACs have an average accuracy rate of 96.4 percent and 3 out of 4 RACs have accuracy rates above 95 percent (one was over 99 percent accurate!).

What is a RAC review?

RAC Review Process RACs review claims on a post-payment basis and will be able to look back three years from the date the claim was paid. There are two main types of review – automated (no medical record required) and complex (medical record required).

Can RAC audits be appealed?

All providers may appeal the initial determination made by the Recovery Audit Contractors, either informally or formally. The informal process involves appealing directly to the contractor within 15 days of receiving a notice to recoup an overpayment from the RAC.

What is a Medicare RAC audit?

RAC audits are run by the Centers for Medicare and Medicaid Services (CMS). Their goal is to uncover improper Medicaid and Medicare claim payments and get the money back. RAC auditors have collected back over $2 billion for CMS.

Who is the Medicaid Recovery Audit Contractor in Illinois?

HMS (hms.com) is under contract with the Illinois Department of Healthcare and Family Services, Office of the Inspector General as Illinois’ Medicaid Recovery Audit Contractor (RAC), pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010.

What is a RAC audit notification letter?

If your practice receives a RAC audit notification letter, it’s generally to investigate suspicion of an improper payment on a claim (either an overpayment or an underpayment). RAC auditors will usually request medical records to complete the audit.

What medical records do RACS need to review?

In the ADR, RACs request records for complex review because their data analyses indicate potentially incorrect billing and improper payment. In three out of four cases, documentation must include the complete medical record including physician query documents, ICD-9-CM coding summary sheet, and UB-04.

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