Recovery Audit Contractor Program

Are You Ready?

Health care providers that offer Medicare services must be more diligent in their record-keeping and more attentive to coding than ever before.

The Recovery Audit Contractor (RAC) program, which is designed to identify improper Medicare payments, recently became a permanent part of the landscape, and by December 31, 2010, the program will expand to include  Medicare parts C and D.

During the three-year Demonstration Program, the RAC auditors identified nearly $1 billion of overpayments in just 3 states. President Obama’s stated goal is to recover $2 billion over the next three years.

RAC audits differ from traditional Medicare audits in a few notable – and potentially costly – ways, so it is important that all providers prepare for them immediately.

RAC auditors are independent contractors, not government employees, so they have experience with data mining and could be reviewing a provider’s records without the provider knowing. If an overpayment is found, the provider is presumed guilty and the overpayment is recouped. The appeals process requires a timely and thorough documentation of services provided. The RAC auditors are paid on a contingency basis, so they are highly motivated to find an i not dotted or a t not crossed.

What We Can Do For You

• Help assemble a RAC team
• Educate others in the organization, including providers
• Assist in developing a RAC plan
• Assist with project management
• Conduct mock RAC audits to prepare your staff
• Identify applicable posted issues
• Establish a RAC "repository"
• Review denials to identify trends
• Perform coding and medical necessity reviews
• Conduct training

Resource:

RAC overview