The adage "no news is fantastic news" unquestionably does not apply to physician offices when it comes to the RAC (Recovery Audit Contractors) program. For the past many years (during the 3-year demonstration program and for the duration of the past year of national expansion), RACs have primarily been focused on hospitals and not individual physician offices. This false sense of security has caused a large number of office managers to put RAC preparations on the back burner. Between now and the finish of the year, we will start off to see RAC rear its ugly head in private-practice physician offices. This article is intended to provide you with some RAC background information, up-to-date status details on the RAC program, and suggestions for assessing your practice's prospective RAC Risk.
Background
The Recovery Audit Contractor (RAC) program was authorized by Congress as component of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). As part of the legislation, Congress directed the Centers for Medicare and Medicaid Services (CMS) to conduct a three-year recovery audit demonstration program in a small number of states.
The objective of the RAC program is to detect and correct improper Medicare payments and to collect those overpayments from providers.
From March 2006 by means of March 2008, the Medicare Recovery Audit Contractor (RAC) demonstration project identified significantly more than $1 Billion in incorrect Medicare payments - which includes some $900 Million on overpayments to facilities and providers.
The obvious success of this demonstration program led to the RAC program getting created permanent as component of The Tax Relief and Wellness Care Act of 2006. This authorized CMS to expand the program in all 50 states.
In the Spring of 2007, CMS began the open bidding method to pick 4 RAC contractors for the permanent RAC project. In October 2008, CMS announced the four (4) new national RACs that had won contracts to serve the Medicare RAC program - roughly 1 RAC for every 1/four of the country.
Those RACs are:
Region A - Diversified Collection Services (DCS)
Region B - CGI Federal
Region C - Connolly Healthcare
Region D - HealthDataInsights (HDI)
Up-to-date RAC status facts:
- According to the American Hospital Association, recovery audit contractors denied $two.47 Million in claims throughout the very first quarter of 2010
- Originally intended for fee-for-service Medicare only, the new wellness care reform law calls for expansion of the RAC program to Medicare Parts C and D by December 31, 2010.
- The new wellness care reform law also calls for RAC expansion into Medicaid programs as nicely by December 31, 2010.
- President Barack Obama is expected to sign a bill into law these days that will expand recovery-audit-type contractor programs beyond Medicare. The Improper Payments Elimination and Recovery ACT demands federal agencies to put audit/corrective action program programs in location to reduce overpayment errors. The White Home cited the success of the present RAC program when announcing plans for additional audit programs. This means that RAC is just the start off and that you ought to anticipate additional audit recovery programs being implemented moving forward.
- Non-governmental insurance companies are taking note of the audit recovery good results as properly. Anthem and Humana are starting to carry out similar audits at hospital and physician levels. Be prepared for the flood gates to open as significantly more and more insurance organizations put similar programs into location.
- Distinctive RAC contractors seem to be focused on several issues. Pay a visit to each and every of the individual contractor sites above for a total listing of concerns in every region.
Understanding is important in terms of assessing your possible RAC Risk. You require to be conscious of where prior improper payments have been found and then take a close look at your own billing tendencies. Here are some recommendations and resources for performing so:
- You can uncover a listing of what improper payments had been located by RACS for the duration of the demonstration period by visiting the CMS internet site at .
- Permanent RAC findings will be listed on the individual regional RAC web-sites. Visit your region's RAC website frequently to keep up to date as new findings/problems are posted frequently.
- Sign up to obtain e-mail notifications with up-to-the-minute RAC facts. I obtain weekly updates from . All it took was signing up for a zero cost registration account through their web page.
- Be proactive! Start off watching and tracking your denied claims. Appear for patterns in the denials to see if you are consistently doing the identical thing more than and more than. Take corrective steps now to prevent incorrect claims and improper payments. If you uncover improper payments as portion of this self-audit, report it to the claims processing contractor. With the contractor's approval, these claims will be excluded from RAC review.
- Watch for updated specifics from Efficiency in Practice through our newsletters, on our webpage and through upcoming complimentary tele-classes.
© 2010 Efficiency in Practice
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