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RAC Contractors to be Identified

7 Responses

1. Executive-Post, on July 29, 2008 at 4:24 PM said:

   RAC Audit Recoveries

   Did you know that auditors have already recovered nearly $700 million in Medicare overpayments to hospitals and other medical providers in a half-dozen states under the controversial Recovery Asset Contractors [RAC] program that pays the auditing firms a portion of amounts they identify?

   In all, the agency’s recovery audit contractor program caught $1.03 billion of improper payments over about three years, primarily in New York, California and Florida, about $992.7 million of which was overpayments by Medicare, according to the Wall Street Journal, July 12, 208.

   The audits also identified about $38 million that providers should have received, but didn’t. The program’s expenses amounted to about 20 cents on the dollar, including $187.2 million paid to the audit firms, and medical providers successfully challenged about $60 million of overpayments identified by the auditors.

   Auditors pointed to the low appeal rate – about 14 percent of overcharges were appealed, and 4.6 percent of the total was overturned – as evidence that the audits succeeded.

   Your thoughts are appreciated as we wonder if “anyone is surprised.”

   -Ann

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2. cmps, on September 3, 2008 at 4:57 PM said:

   RAC Study,

   It seems like people aren’t very optimistic about their chances of escaping a Recovery Audit Contractor [RAC] review unscathed, according to a new study.

   The study, done on behalf of Wolters Kluwer Health, concluded that 40 percent of hospital HIT directors expect to owe funds for Medicare overpayments if audited. The survey found that only 5 percent of HIT directors surveyed think that RAC audits will lead to repayment of funds from Medicare underpayments. Forty-eight percent expect their facility to come out more or less even.

   Your comments are appreciated.
   -Ann

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3. Jackson, on October 9, 2008 at 12:18 AM said:

   RAC

   Did you know that CMS announced four new contractors to administer its Recovery Audit Contractor (RAC) program? The contractors, responsible for auditing provider reimbursement requests, are:

   1. Diversified Collection Services of Livermore, CA
   2. CGI Technologies and Solutions of Fairfax, VA
   3. Connolly Consulting Assoc. of Wilton, CT, and
   4. Health Data Insights of Las Vegas.

   So, expect more contentious debate in the future.

   Jackson

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4. Amy, on September 22, 2009 at 10:56 AM said:

   Here is an article by Cara Engle on what hospitals might do, and expect, with a RAC audit.

   http://www.healthcarefinancenews.com/blog/what-hospitals-should-be-capturing-and-tracking-their-rac-audits

   Cordially,
   Amy

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5. Dr. Marcinko, on March 20, 2010 at 2:54 PM said:

   False Medical Claims Recovery

   Pursuant to Section 6032 of the Deficit Reduction Act of 2005, hospitals and healthcare entities should have a written policy for employees, contractors or agents that provide detailed information about false claims, false statements and whistleblower protections under applicable federal and state fraud and abuse laws.

   This written policy should include a specific discussion of the laws and detailed information regarding other policies and procedures for detecting and preventing fraud, waste and abuse, as well as the rights of employees to be protected as whistleblowers.

   In December 2006, CMS published guidance about implementation of Section 6032 indicating, among other things, that certain contractors or agents (“Covered Contractors/Agents”) should themselves each adopt a policy in compliance with Section 6032.

   According to CMS, Covered Contractors/Agents means any contractor, subcontractor, agent or other person which or who, on behalf of any healthcare entity, furnishes or otherwise authorizes the furnishing of Medicaid health care items or services, performs billing or coding functions, or is involved in the monitoring of health care provided by the entity.

   Forewarned is Forearmed

   Because now, the RACs are nationwide:

   http://pvwlaw.wordpress.com/2009/07/09/recovery-audit-contractors-to-operate-nationwide/

   Dr. David E. Marcinko, MBA
   [Editor-in-Chief]

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6. Joseph, on July 29, 2010 at 1:14 PM said:

   Recovery Audits Expanding to Include Medicaid

   The Centers for Medicare & Medicaid Services is working to expand its recovery audit contractor program to all of Medicare and to the Medicaid program by the end of the year, although an agency official told Congress in July that CMS faces challenges in getting that done on time.

   RACs are third-party auditors hired by CMS to comb through Medicare claims from hospitals, physicians and others to identify improper payments. A three-year RAC demonstration program that launched in California, Florida and New York in 2005 identified roughly $1 billion in Medicare overpayments, according to CMS.

   Source: Chris Silva, AMNews [7/26/10]

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7. Jackson, on November 17, 2014 at 10:43 PM said:

   Three Ways to Avoid a RAC Audit

   Small and medium-sized practices are not below the RAC radar and should heed the following succinct steps to avoid and/or minimize exposure.

   1. Focus on medical decision-making — The OIG and RACs are focusing on the complexity of medical decision-making as your primary determinant for selecting an E&M code. Do not use a higher-level code when the complexity is not there, regardless of how great your documentation may be.

   2. Don’t rely on your EHR’s E&M code selector — I have yet to meet anyone (other than EHR salesmen, of course) who believes these code-selection engines are consistently accurate. This especially holds true with the rising emphasis on medical decision-making. These engines are good training tools but nothing more, in my opinion. They are particularly weak with medical decision-making.

   3. Consider that the use of Level 4 and Level 5 codes for E&M services has increased more than 60 percent since 2001, as EHRs have become commonplace. These higher level codes are a prime RAC target. Don’t let your EHR’s code-selection engine be your coding muse.

   Source: Lucien Roberts, III, Physician’s Practice [11/12/14]

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