RAC Audits

What is RAC?

RAC stands for “Recovery Audit Contractors” and is a program with a very clear mission – to detect and correct incorrect payments so that processes can be put in place to prevent future inaccurate payments.

• CMS can decrease its error rate.
• Providers can defer from submitting claims that aren’t in line with Medicare rules.
• Taxpayers and Medicare beneficiaries are protected.

How It Affects You

Does your practice bill fee-for-service programs? If so, your claims may be audited by the RAC’s.

RACs may attempt to identify improper payments resulting from:

• Incorrect Payment Amounts
• Non-covered Services (Including Services That are Not Reasonably Necessary)
• Incorrectly Coded Services
• Duplicate Services

Your Next Steps

First things first, prepare your practice for a potential RAC review by performing an internal audit. Not only could you find areas that need improvement, but you may discover you’ve been under-reimbursed due to incorrect coding.

HealthCare Management solutions will provide your practice with a baseline audit of your practice’s billing and coding. If there are errors or discrepancies, our certified and experienced auditors will find them.

CMS-RAC Audit Preparation

• Keep track of denied claims and look for patterns.
• Promote compliance by taking corrective action.
• Work with our team to perform an audit of all paid claims.
• Implement policies and procedures to prevent any future billing errors.