Understanding Medicare Recovery Audit Contractor (RAC)

1. Medical Billers and Coders Understanding Medicare Recovery Audit Contractor (RAC) Audit

2. What is Recovery Audit Contractor Audit? • As a combined effort to fight fraud, waste, and abuse in the Medicare program, Recovery Audit Contractor (RAC) audit was in place from January 1, 2010. The goal of the recovery audit contractor program is to identify improper payments made on claims for services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. • Overpayments can occur when providers submit claims that do not meet CMS coding or medical necessity policies. • Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

3. The goal of the Recovery Audit Contractor As discussed above, RAC contractors are tasked with identifying improper payments made on claims of health care services provided to Medicare beneficiaries. Under most circumstances, the RAC will request medical records from the provider to determine whether overpayment and/or underpayment have occurred.

4. Filing an Appeal The RAC Contractor has the ability to perform extrapolation based on improper payments identified during a review. If you receive an overpayment demand letter, and if you believe the request for overpayment is unjustified, you must file an appeal. You can file an appeal within 30 days of receipt of the overpayment demand letter to avoid a Medicare recoupment action. Interest begins to accrue 31 days from the receipt of the overpayment letter regardless of whether an appeal is filed. No interest accrues if repayment occurs within 90 days. You have to call the RAC within 15 days from the date you receive the demand letter to discuss the overpayment and send any evidence to counter an offset. Note that calling your RAC does not constitute a formal appeal.

5. To summarize Outsourcing Medical billing is complex, and your staff must be knowledgeable about many areas pertaining to billing and reimbursement. You have to establish compliance and practice standards and need to conduct internal monitoring and auditing to evaluate adherence. Your staff must stay current on coding requirements, need to keep up with industry changes, understand the denial and appeal processes, and be able to identify resources for support.  If you are audited, most importantly, do not ignore a letter from the RAC auditor. If you are worried about your billing compliances with Medicare, you can take assistance from us. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle management services. We can assist you in medical billing and coding for Medicare, Medicaid, and for all private insurance carriers.

6. Email : info@medicalbillersandcoders.com Fax no: 888-316-4566 Toll Free no: 888-357-3226 AddressWilmington, 108 West, 13th street, Wilmington, DE 19801Texas, 539 W. Commerce St #1482 Dallas, TX 75208