Quick Guide to the Medicare Recovery Audit Contractor (RAC) Program

No Need to “RAC” Your Brain!

Published by Medical Business Systems Practice Management Software.

The purpose of the RAC program is to identify and

correct both over- and underpayments .

The ultimate goal is to provide CMS with

payment analysis that will prevent future

improper payments.Recovered over $900

million in overpayments

Reimbursed providers $38

million in underpayments

Audits from 2005 -2008

Typical causes of improper payments:1. Incorrect payment amounts2. Non-covered services3. Incorrectly coded services4. Duplicate services

Records are reviewed in the US

by: certified coders, nurses,

therapists, and a physician

(CMD)

A B

C D

States: CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI and VT.

States: IL, IN, KY, MI, MN, OH and WI.

States: AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico and U.S.V.I.

States: AK, AZ, CA, HI, ID, IA, KS, MO, MT, ND, NE, NV, OR, SD, UT, WA, WY, Guam, American Samoa and Northern Marianas.

Performant Recoverywww.Performantrac.com

Info@performantrac.com1‐866‐201‐0580

Connolly, Inc.

CGI

HealthDataInsights

http://racb.cgi.comracb@cgi.com1‐877‐316‐7222

www.connollyhealthcare.com/RACRACinfo@connollyhealthcare.co1‐866‐360‐2507

http://racinfo.healthdatainsights.comracinfo@emailhdi.comPart B: 866 376 2319‐ ‐

The US and it’s territories are divided into 4 RAC Jurisdictions.

Do you have questions or comments about the Recovery Audit Program? You can e-mail CMS at: RAC@cms.hhs.gov.

Demand letters are sent from the MAC and interest is accrued from the accounts receivable/letter date.

Source CMS.gov

Recovery Auditors are required to post on their websites the CMS-approved issues that may trigger a Recovery Auditor review.

The RAC is required to provide detailed results with

the rationale used to arrive at the determination.