| The adage "no news is good news" definitely does not | | | | December 31, 2010. |
| apply to physician offices when it comes to the RAC | | | | - The new health care reform law also calls for RAC |
| (Recovery Audit Contractors) program. For the past | | | | expansion into Medicaid programs as well by |
| several years (during the 3-year demonstration | | | | December 31, 2010. |
| program and during the past year of national | | | | - President Barack Obama is expected to sign a bill |
| expansion), RACs have primarily been focused on | | | | into law today that will expand recovery-audit-type |
| hospitals and not individual physician offices. This false | | | | contractor programs beyond Medicare. The Improper |
| sense of security has caused many office managers | | | | Payments Elimination and Recovery ACT requires |
| to put RAC preparations on the back burner. Between | | | | federal agencies to put audit/corrective action plan |
| now and the end of the year, we will start to see | | | | programs in place to reduce overpayment errors. The |
| RAC rear its ugly head in private-practice physician | | | | White House cited the success of the current RAC |
| offices. This article is intended to provide you with | | | | program when announcing plans for additional audit |
| some RAC background information, up-to-date status | | | | programs. This means that RAC is just the start and |
| information on the RAC program, and tips for | | | | that you should anticipate additional audit recovery |
| assessing your practice's potential RAC Risk. | | | | programs being implemented moving forward. |
| Background | | | | - Non-governmental insurance companies are taking |
| The Recovery Audit Contractor (RAC) program was | | | | note of the audit recovery success as well. Anthem |
| authorized by Congress as part of the Medicare | | | | and Humana are starting to perform similar audits at |
| Prescription Drug, Improvement and Modernization Act | | | | hospital and physician levels. Be prepared for the flood |
| of 2003 (MMA). As part of the legislation, Congress | | | | gates to open as more and more insurance |
| directed the Centers for Medicare and Medicaid | | | | companies put similar programs into place. |
| Services (CMS) to conduct a three-year recovery | | | | - Different RAC contractors seem to be focused on |
| audit demonstration program in a small number of | | | | different issues. Visit each of the individual contractor |
| states. | | | | websites above for a complete listing of issues in each |
| The goal of the RAC program is to detect and | | | | region. |
| correct improper Medicare payments and to collect | | | | |
| those overpayments from providers. | | | | Assessing Your Risk |
| From March 2006 through March 2008, the Medicare | | | | Knowledge is key in terms of assessing your potential |
| Recovery Audit Contractor (RAC) demonstration | | | | RAC Risk. You need to be aware of where previous |
| project identified more than $1 Billion in incorrect | | | | improper payments have been found and then take a |
| Medicare payments – including some $900 Million on | | | | close look at your own billing tendencies. Here are |
| overpayments to facilities and providers. | | | | some tips and resources for doing so: |
| The obvious success of this demonstration program | | | | - You can find a listing of what improper payments |
| led to the RAC program being made permanent as | | | | were found by RACS during the demonstration period |
| part of The Tax Relief and Health Care Act of 2006. | | | | by visiting the CMS website at |
| This authorized CMS to expand the program in all 50 | | | | - Permanent RAC findings will be listed on the individual |
| states. | | | | regional RAC websites. Visit your region's RAC |
| In the Spring of 2007, CMS began the open bidding | | | | website frequently to keep up to date as new findings |
| process to select four RAC contractors for the | | | | issues are posted regularly. |
| permanent RAC project. In October 2008, CMS | | | | - Sign up to receive email notifications with |
| announced the four (4) new national RACs that had | | | | up-to-the-minute RAC information. I receive weekly |
| won contracts to serve the Medicare RAC program | | | | updates from All it took was signing up for a free |
| – roughly one RAC for each ¼ of the country. | | | | registration account via their website. |
| Those RACs are as follows: | | | | - Be proactive! Start watching and tracking your |
| Region A | | | | denied claims. Look for patterns in the denials to see if |
| Diversified Collection Services (DCS) | | | | you are consistently doing the same thing over and |
| Region B | | | | over. Take corrective steps now to avoid incorrect |
| CGI Federal | | | | claims and improper payments. If you uncover |
| Region C | | | | improper payments as part of this self-audit, report it to |
| Connolly Healthcare | | | | the claims processing contractor. With the contractor's |
| Region D | | | | approval, these claims will be excluded from RAC |
| HealthDataInsights (HDI) | | | | review. |
| Up-to-date RAC status information: | | | | - Watch for updated information from Efficiency in |
| - According to the American Hospital Association, | | | | Practice through our newsletters, on our website and |
| recovery audit contractors denied $2.47 Million in claims | | | | via upcoming complimentary tele-classes. |
| during the first quarter of 2010; | | | | Bottom-line, recovery audits of all types are here to |
| - Originally intended for fee-for-service Medicare only, | | | | stay. You need to be aware of the risk, continually |
| the new health care reform law calls for expansion of | | | | seek education and resources on the topic, and be |
| the RAC program to Medicare Parts C and D by | | | | proactive with your preparation. |