What triggers RAC audits?
RAC audits are not one-time or intermittent reviews and can be triggered by anything from an innocent documentation error to outright fraud. They are part of a systematic and concurrent operating process that ensures compliance with Medicare’s clinical payment criteria, documentation and billing requirements.
What are RAC audits looking for?
The objective of this program is to discover any improper payments that are charged for uncovered services. These include services that are deemed “not reasonably necessary.” The RAC audits also focus on discrepancies such as fraud, duplicative services, wrong coding, and so on.
How do you respond to RAC audit?
If the audit of your records determines you received an overpayment, you will receive an overpayment demand letter from the RAC….In response to an overpayment demand letter, you essentially have three options:
- Pay it in full.
- Request an extended repayment schedule.
- File an appeal.
How can RAC audits be prevented?
6 Critical Tips to Avoid RAC Audits
- Have a Risk-Management Plan in Place.
- Use Task and Employee Performance Checklists.
- Pay Attention to EHR Templates and Software Up-Coding.
- Avoid the Overuse of Levels 4 and 5 in E/M Codes.
- Control Errors and Expenses with an Independent Audit.
Are RAC audits random?
Look-back Period, Required Response Time and Appeals A Complex audit is a comprehensive review of charts and claims, while an automated audit is more of a random spot check of files. For each type, the “look-back” period is up to three (3) years of claims records.
Can RAC audits be appealed?
All providers may appeal the initial determination made by the Recovery Audit Contractors, either informally or formally. The informal process involves appealing directly to the contractor within 15 days of receiving a notice to recoup an overpayment from the RAC.
What is the difference between Mac and RAC?
MAC audits are powerful and intrusive procedures that have the potential to lead to serious federal charges for healthcare entities. A Recovery Audit Contractor (“RAC”) reviews claims and identifies overpayments from Medicare so that CMS and other auditors are able to prevent improper payments in the future.
What is a RAC audit in Medicare?
What does a Recovery Audit Contractor (RAC) do? RAC’s review claims on a post-payment basis. The RAC’s detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.
How are RAC audits paid?
RACs are paid on a contingency fee basis, which means they are reimbursed based on a percentage of the improper payments they find or collect. The amount of the contingency fee is based on the amount of money from, or reimbursed to, providers.
What is a RAC review?
RAC Review Process RACs review claims on a post-payment basis and will be able to look back three years from the date the claim was paid. There are two main types of review – automated (no medical record required) and complex (medical record required).