Revenue Cycle

Q&A: RAC review

Recovery Auditor Report, October 2, 2008

Question: If a provider has performed a self-audit prior to RAC review and wants to extrapolate these findings, will all these claims included in a self-audit be excluded from RAC review?

CMS’ answer: If a provider self-discloses a payment error and the Claims Processing Contractor confirms that a payment error exists and the sampling/extrapolation methodology used was correct, then these claims will not be reviewed by the RAC. The claims processing contractor will exclude the self-disclosed claims in the RAC data warehouse.

Source: Centers for Medicare & Medicaid Services

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