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 panorama program using Recovery Display Contractors ( RACs ) to detect and correct wrongful payments in the Medicare FFS program.
The Recovery Fresh look Contractor ( RAC ) ostentatiousness program was designed to drive whether the use of RACs will be a cost - effective means of adding resources to nail down correct payments are being made to providers and suppliers and, thus, protect the Medicare Credence Cabbage. The frippery operated in New York, Massachusetts, Florida, South Carolina and California and ended on Trudge 27, 2008.
RACs succeeded in correcting more than $1. 03 billion of Medicare vicious payments Approximately 96 % of these were overpayments laid-back 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 lifelong and requires the Secretary to expand the program to all 50 states by no next than 2010.
According to CMS, the RAC grandstand play program has proven to be triumphant in returning dollars to the Medicare Credit Funds and identifying monies that need to be shared to providers. It has provided CMS with a new mechanism for detecting biased payments made in the bygone, and has also given CMS a hot new tool for preventing future payments.
The end of the recovery study program is to spot discreditable payments made on claims of health care services provided to Medicare beneficiaries. Mean payments may be overpayments or underpayments. Overpayments can eventuate when health care providers proffer claims that do not meet Medicare ' s coding or medical retrenchment policies. Underpayments can materialize when health care providers charge claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed. Health care providers that might be reviewed consist of 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 nail down that you are in line with the regulations required by the Centers for Medicare and Medicaid Services so that you can take corrective dash immediately if inconsistencies are identified.