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 exposure program using Recovery Review Contractors ( RACs ) to detect and correct grievous payments in the Medicare FFS program.
The Recovery Scrutiny Contractor ( RAC ) showboat program was designed to regulate whether the use of RACs will be a cost - effective means of adding resources to establish correct payments are being made to providers and suppliers and, therefrom, protect the Medicare Stock Green stuff. The grandstand play operated in New York, Massachusetts, Florida, South Carolina and California and ended on Pace 27, 2008.
RACs succeeded in correcting more than $1. 03 billion of Medicare shameless payments Approximately 96 % of these were overpayments effortless 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 durable and requires the Secretary to expand the program to all 50 states by no succeeding than 2010.
According to CMS, the RAC display program has proven to be on track in returning dollars to the Medicare Assurance Funds and identifying monies that need to be common to providers. It has provided CMS with a new mechanism for detecting unsporting payments made in the preceding, and has also liable CMS a worthy new tool for preventing future payments.
The use of the recovery reassessment program is to ascertain biased payments made on claims of health care services provided to Medicare beneficiaries. Inequitable payments may be overpayments or underpayments. Overpayments can befall when health care providers submit claims that do not meet Medicare ' s coding or medical insufficience policies. Underpayments can arise 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 carry 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 arrange that you are in line with the regulations required by the Centers for Medicare and Medicaid Services so that you can take corrective energy immediately if inconsistencies are identified.