No Need to "RAC" Your Brain Over Medicare RAC Program
4
Quick Guide to the Medicare Recovery Audit Contractor (RAC) Program No Need to “RAC” Your Brain! Published by Medical Business Systems Practice Management Software.
-
Upload
medical-business-systems -
Category
Documents
-
view
36 -
download
3
description
Quick guide to the Medicare Recovery Audit Contractor (RAC) Program.
Transcript of No Need to "RAC" Your Brain Over Medicare RAC Program
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
[email protected]‐866‐201‐0580
Connolly, Inc.
CGI
HealthDataInsights
http://[email protected]‐877‐316‐7222
www.connollyhealthcare.com/[email protected]‐866‐360‐2507
http://[email protected] 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: [email protected].
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.
