RAC Appeals Houston
A RAC audit refers to a Recovery Audit Contractor audit, a type of review conducted by contractors working on behalf of the Centers for Medicare & Medicaid Services (CMS). These audits aim to identify and recover improper Medicare payments made to healthcare providers.
Key points about RAC audits:
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Purpose: To detect and correct overpayments and underpayments in Medicare Part A and Part B claims.
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Auditors: CMS hires private companies, called Recovery Audit Contractors (RACs), to conduct the reviews.
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Scope: RACs can audit a variety of claims, such as inpatient hospital stays, outpatient services, physician services, and durable medical equipment (DME).
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Retrospective: RACs typically review past claims, sometimes up to 3 years old.
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Payment Incentive: RACs are paid a percentage of the money they recover, which incentivizes thorough reviews.
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Appeal Rights: Providers have the right to appeal RAC findings through a multi-level administrative process.
Common issues RACs look for:
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Duplicate claims
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Incorrect coding or upcoding
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Medically unnecessary services
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Lack of documentation to support services billed
If you’re a provider dealing with a RAC audit, it’s essential to:
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Respond to documentation requests promptly
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Review the audit findings carefully
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Be prepared to appeal if you believe the audit was incorrect
RAC Appeals Houston
