Medicare Rac Audits - What Are They And What Do They Mean To Your Practice?

Medicare Rac Audits - What Are They And What Do They Mean To Your Practice?

In section 306 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( MMA ), Congress directed the Department of Health and Human Services ( DHHS ) to conduct a 3 - year splurge program using Recovery Report Contractors ( RACs ) to detect and correct iniquitous payments in the Medicare FFS program.
The Recovery Second look Contractor ( RAC ) expo program was designed to bias whether the use of RACs will be a cost - effective means of adding resources to certify correct payments are being made to providers and suppliers and, and so, protect the Medicare Certainty Riches. The vanity operated in New York, Massachusetts, Florida, South Carolina and California and ended on March 27, 2008.
RACs succeeded in correcting more than $1. 03 billion of Medicare arbitrary payments Approximately 96 % of these were overpayments indifferent from providers, while the remaining 4 percent were underpayments repaid to providers.
Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC Program continuing and requires the Secretary to expand the program to all 50 states by no following than 2010.
According to CMS, the RAC example program has proven to be noteworthy in returning dollars to the Medicare Conviction Funds and identifying monies that need to be retaliated to providers. It has provided CMS with a new mechanism for detecting unjust payments made in the elapsed, and has also addicted CMS a scarce new tool for preventing future payments.
The mission of the recovery check-up program is to discern improper payments made on claims of health care services provided to Medicare beneficiaries. Dishonorable payments may be overpayments or underpayments. Overpayments can materialize when health care providers bid claims that do not meet Medicare ' s coding or medical default policies. Underpayments can materialize when health care providers propose claims for a simple procedure but the medical enter reveals that a more complicated procedure was actually performed. Health care providers that might be reviewed build in hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B.
It is now more critical than ever that you review your current billing and compliance policies to make safe that you are in line with the regulations required by the Centers for Medicare and Medicaid Services so that you can take corrective business immediately if inconsistencies are identified.