Take note: 10 RAC facts to consider
Recovery Auditor Report, January 22, 2009
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Consider the following 10 RAC facts:
- RAC must send only one review result per claim (e.g., coding and medical necessity review must be in same letter)
- RAC must report potential fraud immediately
- RAC must report potential quality issues
- RAC may receive “tips” from CMS, affiliated contractors, Office of Inspector General, law enforcement or other agencies
- Recoupment is through current or future Medicare payments
- Provider can repay through installment plans up to 12 months, or longer with approval
- Debtor (e.g., hospital or healthcare provider) can present RAC with settlement offer
- RACs will receive smaller fee if providers voluntarily self-report after receiving a medical record request or demand letter
- RAC must provide a toll-free customer service number to all providers
- 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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