Revenue Cycle

Take note: 10 RAC facts to consider

Recovery Auditor Report, January 22, 2009

Consider the following 10 RAC facts:

  1. RAC must send only one review result per claim (e.g., coding and medical necessity review must be in same letter) 
  2. RAC must report potential fraud immediately 
  3. RAC must report potential quality issues 
  4. RAC may receive “tips” from CMS, affiliated contractors, Office of Inspector General, law enforcement or other agencies 
  5. Recoupment is through current or future Medicare payments 
  6. Provider can repay through installment plans up to 12 months, or longer with approval 
  7. Debtor (e.g., hospital or healthcare provider) can present RAC with settlement offer 
  8. RACs will receive smaller fee if providers voluntarily self-report after receiving a medical record request or demand letter 
  9. RAC must provide a toll-free customer service number to all providers 
  10. RAC shall provide the CMS project office with all correspondence containing complaints

Editor’s note: These facts were provided by Linda M. Fotheringill, Esq., of Washington & West, LLC, in Baltimore, MD, during the January 6 HCPro, Inc., audio conference, “RAC Readiness: Develop an Effective Audit Tracking System.” To listen to the audio conference, visit www.hcmarketplace.com/prod-7371.html.

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