medicare recovery audit contractor rac program n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Medicare Recovery Audit Contractor (RAC) Program PowerPoint Presentation
Download Presentation
Medicare Recovery Audit Contractor (RAC) Program

Loading in 2 Seconds...

play fullscreen
1 / 13

Medicare Recovery Audit Contractor (RAC) Program - PowerPoint PPT Presentation


  • 138 Views
  • Uploaded on

Medicare Recovery Audit Contractor (RAC) Program. Jennifer Amann, MBA Healthcare Resource Providers, LLC. Recovery Audit Contractors. Goal: Identify overpayments and underpayments made by CMS to providers Four contractors hired by Medicare to conduct audits

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Medicare Recovery Audit Contractor (RAC) Program' - halee-atkins


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
medicare recovery audit contractor rac program

Medicare Recovery Audit Contractor (RAC) Program

Jennifer Amann, MBA

Healthcare Resource Providers, LLC

recovery audit contractors
Recovery Audit Contractors
  • Goal: Identify overpayments and underpayments made by CMS to providers
  • Four contractors hired by Medicare to conduct audits
    • Regional rollout started in March 2009
    • Scheduled to involve all 50 states by 2010
  • Paid based on “savings” to Medicare program
    • Incentive to find incorrect overpayments
rac contractors
RAC Contractors
  • Diversified Collection Services, Inc. (A)
    • www.dcsrac.com
  • CGI Technologies and Solutions, Inc. (B)
    • www.racb.cgi.com
  • Connolly Consulting Associates, Inc. (C)
    • www.connollyhealthcare.com
  • HealthDataInsights (D)
    • www.racinfo.healthdatainsights.com
rac websites
RAC Websites
  • Sample audit request letters
  • List of approved issues for review
    • Example: Diversified Collection Services
      • 7 Inpatient hospital issues (most DRG related)
      • 11 DME
      • 1 Ambulance providers
      • 1 Clinical social workers (CSW)
    • Detailed descriptions and policy-related links provided
  • Radiology procedures currently most likely to be pulled in from inpatient hospital issues
medical record review
Medical Record Review
  • RACs must have a physician medical director and certified coders
    • Must provide credentials upon request
  • No audits on claims paid before 10/1/2007
    • Limited to 3-year retrospective review
  • CMS sets limits per year
    • Covers the number of medical records that can be requested per 45-day period
medical record review limitations
Medical Record Review Limitations
  • 2009 limits for Part B providers
    • 10 records for solo practitioners
    • 20 for 2-5 physicians
    • 30 for 6 -15 physicians
    • 50 for groups of 16 or more
  • Number of records can be adjusted annually
    • No updates for 2010 published yet
rac letters
RAC Letters
  • Specify coverage, coding or payment policy violated
  • Reason for review
  • Description of overpayment situation
  • Recommended corrective actions
  • Explanation of:
    • Provider’s right to submit a rebuttal statement prior to recoupment of overpayments
    • Procedures for recovery of overpayments
    • Right to request extended repayment schedule
    • Right to appeal
    • Other requirements for written notifications
audit process
Audit Process
  • Typically practices will receive letters requesting medical records
  • Auditors have authority to go on site to view and copy records
    • Practices can refuse access, however
    • RAC then needs to provide written request for copies
educational resources
Educational Resources
  • Watch for RAC contractor outreach activities
    • Several have scheduled presentations at industry association meetings
  • CMS has announced series of free educational teleconferences
    • April 28, 2010
      • RAC 101
    • May 12, 2010
      • RAC 101 for Physicians
    • Calls scheduled 1:00 – 2:30 EST
      • 877-251-0301
preparing for the rac
Preparing for the RAC
  • What were the results of recent CERT audits?
  • Track coding and medical necessity denials for patterns
  • Conduct internal coding audits
    • What was ordered was what was done
    • What was done was what was billed
    • What was billed was what was paid
the bigger picture
The Bigger Picture
  • Overall Medicare auditing/enforcement actions
    • CERT
    • ZPIC (Medicare Zone Program Integrity Contractors)
    • RAC
  • ZPIC compliance efforts (assigned based on MAC jurisdictions)
    • Data analysis and data mining
    • Medicare reviews to support “benefit integrity”
    • Supporting law enforcement and answering complaints
    • Investigating fraud and abuse
    • Recommending recovery of Federal funds through administrative action
    • Referring cases to law enforcement
thank you
Thank you!

Jennifer Amann, MBA

Healthcare Resource Providers, LLC

P.O. Box 90190

Albuquerque, NM 87199

Cell: 817-406-3355

jkroken@radconsultants.com

www.radconsultants.com