Key differences in nationwide RAC rollout
Patient Financial Services Weekly Advisor, October 31, 2008
Now that you know which Medicare Recovery Audit Contractor (RAC) will come to your facility, it’s time to prepare for some changes. CMS revamped the program after the three-year demonstration project, and providers can expect to see the changes reflected in the nationwide permanent program.
Chief among them are:
RAC medical director
Demonstration RACs: Not required
Permanent RACs: Mandatory
Coding experts
Demonstration RACs: Optional
Permanent RACs: Mandatory
Credentials of reviewers provided upon request
Demonstration RACs: Not required
Permanent RACs: Mandatory
Discussion with CMD regarding claim denials if requested
Demonstration RACs: Not required
Permanent RACs: Mandatory
AC validation process
Demonstration RACs: Optional
Permanent RACs: Limited
External validation process
Demonstration RACs: Not required
Permanent RACs: Mandatory
RAC must pay back the contingency fee if the claim is overturned on appeal
Demonstration RACs: Only required if claim is overturned on the first level of appeals
Permanent RACs: Required if claim is overturned at all levels of appeals
Maximum look back date
Demonstration RACs: None
Permanent RACs: October 1, 2007
RACs allowed to review claims in current fiscal year
Demonstration RACs: No
Permanent RACs: Yes
RACs solely for MSP
Demonstration RACs: Yes
Permanent RACs: No
RAC claim status Web page
Demonstration RACs: Not required
Permanent RACs: By January 2010
Limits on number of medical records requested
Demonstration RACs: Optional. Each RAC sets own limit
Permanent RACs: Mandatory. CMS will establish uniform limits.
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