By now the Recovery Audit Contractors (RACs) have begun their reviews. In the early stages they have been primarily focusing on the Inpatient Hospital setting with some issues being reviewed for Outpatient Hospital, Durable Medical Equipment (DME) and Physician settings.

Whatever category you fall into, it is never too early to begin reviewing your coding and billing procedures. The RACs can review charts as far back as October 2007. If you are not sure of your coding or would like to catch mistakes and correct them now, an independent baseline audit would be a good recommendation. An experienced, certified coder can actually save you money. The sooner you can correct errors in your coding and billing, the more you save yourself in potential repayments to Medicare.

To find the latest news and updates, and the most current list of approved issues for audit in your region, click here.

Labels: coding and billing, rac audit, recovery audit contractors

If you are a Medicare fee for service provider, you may have heard of the RACs by now. A RAC is a Recovery Audit Contractor, authorized by Medicare to audit any and all fee for service providers for improper payments. There are four RACs, each responsible for a region of the country. They are separate from your local Medicare carrier, so do not confuse a RAC audit with an audit from your local carrier. They are two separate entities. If you receive a letter from a RAC notifying you that you are being audited, it will be on their letterhead, not your local carrier's.

RACs review Medicare claims filed by providers on a post-payment basis. There is a three year look back period, so they cannot review anyclaims older than October 2007. The Centers for Medicare and Medicaid Services authorize which issues the RACs are allowed to audit, and these approved issues are required to be posted to the RACs website as public knowledge. So at any time, a provider may check their region's RAC website and see if any services they provide have been approved for audit.

The auditors use the same Medicare polices as carriers, FIs and MACs. They are subject to all NCDs, LCDs, and CMS Manuals. Each RecoveryAudit Contractor is also required to employ a staff consisting of nurses, therapists, certified coders, and a physician CMD.

There are two types of review: Automated, in which no medical record will be needed from you. The RAC reviews these claims by an automatedcomputer algorithm. You should be able to identify at which point you have been audited by the automated process. A remittance advice will be issued with the remark code N432: Adjustment based on Recovery Audit. Your local carrier recoups the overpayment by offset on future claims payments unless you submit a check or a valid appeal.

The second type of review is complex. This is where you will be contacted with a request to send in medical records for the claims under review. There is a limit to the number of files that the contractor can request every 45 days.

This is a brief summary of the process. More information can be found here.

Labels: cms audit, medicare audit, rac audit

For detailed information about the RAC you can visit the official Medicare website at http://www.cms.hhs.gov/RAC

Profast Billing Solutions offers a random 50 chart audit for providers, hospitals, home health agencies, durable medical equipment providers. Let us help you identify any errors in coding, documentation and billing. We also provide educational webinars for providers and staff. Learn more at profastbilling.com

Labels: medicare audit, rac audit, recovery audit contractor

There is a lot of talk out there on blogs and article posts by physicians regarding the Medicare RAC audits that will be starting in full force soon. Is the RAC audit a big deal? You bet! The majority of physicians may have a good handle on their billing and coding, and the vast majority of physicians do not commit fraud. They may think they are safe from the CMS RAC audit...but think again.

All would be good and well if they were just looking for instances of fraud, abuse, or sloppy coding. But keep in mind, they are compensated to find errors, and even a small technicality may wind up costing you thousands of dollars. Medicare states that you can challenge the RACs findings, but if you've ever dealth with the appeals process, you know how that can be.

For a good opinion and more information, you can go to the article "When Fraud isn't Fraudulent" here.

A good way to protect yourself and potentially save your practice thousands of dollars is to catch any errors well in advance of the RAC audit. An independent third-party review by a qualified company is an excellent choice. For more information, click here.

Labels: cms audit, medicare audit, rac audit

So you got the notice...the Medicare RAC is coming to your practice. No big deal? Think again. The Medicare audit
of all beneficiaries of Medicare payments ( i.e. - those who file claims with Medicare ) is here to stay and if your
practice is out of compliance, it could end up costing you thousands of dollars. It's not all gloom and doom, however.
Follow a few simple steps to help get your practice prepared.

First, a little about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration
in California, New York, Florida and 3 other states. The purpose - to discover areas of fraud and waste and recover overpayments made by Medicare
due to improper coding and compliance with Medicare guidelines. The result - over $900 million in overpayments recovered and returned
to the Medicare Trust Fund. With the success, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico
no later than January 1, 2010.

Don't expect it to go away either...this program is to be permantely in place.

Anyone who files claims with Medicare, physicians, hospitals, home health agencies and durable medical equipment providers are all affected. What does this
all mean to you? If you fall into one of the above categories, expect a notice soon from the contractor in charge of the audit in your region. Don't expect
them to tell you what they are looking for, however. That is left up to you. The RACs are compensated on a contingency basis based on the amount of
overpayments that they find. You think they are going to be aggressive? You betcha! The penalties for overpayments? At the very least, overpayments
will have to be returned. And Medicare isn't going to send you an invoice and wait for the money...they will just take a portion of your current and future
claims payments until the overpayment is paid in full. In extreme cases, Medicare may suspend a practices claims privileges all together.

Protect yourself by following a few easy procedures.

First, consider conducting an internal assessment of submitted claims to make sure they follow Medicare guidelines. Either you, your staff, or a third-party
auditor can do this. However, a qualified third-party auditor may be the best option as this allows for someone outside your practice to give you a second
opinion. If you do choose to do it yourself, look for claims that have been denied in the past and and review the RAC's website.

Consider having a certified coder review a sample of your files and help you identify any pattern of inconsistent or improper coding. Again, a third-party audit
service is an excellent option. A qualified auditor should have certified coders on staff, preferably with governemt auditing experience as well.

Comply with Medicare's request for medical records in a timely manner. Failure to do so may cost you the right to appeal any decisions by the RAC that you disagree with.

Finally, implement corrective actions to ensure compliance with Medicare guidelines prior to the RAC visit to your office. The sooner you do this, the less money you
will cost yourself when the RAC finally gets around to you. If you choose to use a third-party auditor to assist you, they should provide you with a report on areas
for improvement as well as consult with you on other areas of compliance as well.

With the right preparation and implementation of processes, you don't have to fear the RAC. Besides, some good may come out of your audit. During the same demonstration
in the above mentioned states, $38 million in underpayments to providers was made. You may find areas where you have been underpayed, so it isn't all bad news.

For detailed information about the RAC you can visit the official Medicare website at www.cms.hhs.gov/RAC.

To learn more about our independent base line audit to prepare you for the RAC, go here.

Labels: cms audit, medicare audit, rac audit