There’s a new hired gun in town, and it’s name is RAC.  Yup, pardner, Recovery Audit Contractor.  This new breed of watch dog is charged with auditing your medicare claims, sniffing out over payments and noncompliance of every practitionerin the United States (and Puerto Rico, for those who care.)  The expanded RAC will be in your neighborhood sometime this year.  These government hired contractors are paid by percentage of overpayments  found.  That’s right, the more errors they find, the more money they earn.  Suffice to say they will be highly motivated to find your documentation, coding and compliance errors.

So what’s a good doctor to do?  (No, throwing your hands up in despair isn’t one of the options!) Remember first that it is the physician’s responsibility to make sure documentation is up to snuff, coding is appropriate for the level of service, and that billing meets CMS guidelines.

  • Be prepared. There will be automated reviews and/or requests for chart review.  Chart review is usually initiated when an automated audit doesn’t provide sufficient information to resolve the issue.
  • Know there is an appeals process, but not a simple one. It is the standard Medicare A and B appeals process.
  • Consider auditing your own charts before the RAC attack begins. Find and correct errors before you get audited.
  • Know what the RAC is looking for: duplicate services, services that were not indicated, uncovered services, incorrect coding.
  • Respond in 45 days to medical records requests.  (BTW–the RAC is required to pay for copies of records.)
  • Know the penalties:  interest will be charged on amounts owed back to  the Feds for over payments.

So, add this to your  burgeoning to do list.  As if medicare payments  weren’t small enough!  The biggest losers are hospitals that rely on Medicare A. Next up is, of course, the primary care doc. How many specialists rely heavily on Medicare?

Now that you’ve been JCAHO’d it’s time to get RAC’d

Leave a Reply

Your email address will not be published. Required fields are marked *