Health Information Management

AHA weighs in on Part C RACs

HIM-HIPAA Insider, March 8, 2011

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

On February 23, the American Hospital Association sent a letter to CMS regarding the expansion of RAC into Medicare Part C.

The AHA urged CMS to implement the Part C RAC program in a manner that focuses on accuracy of payments from Medicare to the Medicare Advantage (MA)plans instead of requiring MA plans to create a separate RAC program.

In addition, the letter contained 15 recommendations, including:

  • Excluding medical necessity review (MNR) from the program
  • Requiring trained medical professionals to conduct RAC audits
  • Limiting RACs to a 12-month look-back period
  • Necessitating close CMS oversight of RACs and specifically assigning CMS staff to address provider concerns with Medicare Advantage plan RACs
  • Requiring CMS approval of each audit issue before the RAC conducts the audit

 For more information, visit the HCPro Revenue Cycle Institute.



Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Most Popular