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RAC Audit

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Detailed explanation about the RAC audits that the CMS will be performing nationwide

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Recovery Audit Contractors (RACs) Medicare. Medicaid and Commercial Insurance Investigations What you Need to Know
Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recovery Audit Contract-”RAC” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Regions and timelines *RACs are required to perform outreach programs for all providers in their region From CMS D C B A March 1, 2009 March 1, 2009 March 1, 2009 March 1, 2009 March 1, 2009 March 1, 2009 August 1, 2009 August 1, 2009 August 1, 2009 Provider Outreach Claims Available for Analysis Earliest Correspondence
How the RAC affect the Provider If the providers bill Fee-for-Service Medicare, Medicaid or Commercial Insurance programs, their claims will be subject to review by the investigators and auditors
Who has the Authority ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What about the other entities ,[object Object],[object Object],[object Object],[object Object],codeXpress. Providers Coding Resource
What does the RAC do? ,[object Object],[object Object],[object Object],[object Object]
Fiscal Year 09 Medical Record Limits ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to Prepare Your Providers ,[object Object],[object Object],[object Object]
How Providers Get Prepared ,[object Object],[object Object],[object Object]
Importance of Documentation Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Beyond the BaseLine Review ,[object Object],[object Object],[object Object],[object Object],Be the solution
When the RAC arrives ,[object Object],[object Object],[object Object],[object Object],[object Object]
Next Steps from the RAC ,[object Object],[object Object]
The Collection Process ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Disagreement –No Appeal ,[object Object],[object Object],[object Object]
Appeals ,[object Object],[object Object],[object Object],[object Object]
What to Expect Next ,[object Object]
Where do they turn- YOU ,[object Object],[object Object],[object Object],[object Object]
RAC Preparation Support Medicare Documentation & Coding Benchmark Audit ,[object Object],[object Object],Fax to HIPAA secure site (iDocumentNow) for certified coders to review Documentation and coding Compliance audit performed by certified coders Web-based Training Audit Report ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sample report to follow
Guess who’s coming to the Audit Table ,[object Object],[object Object],[object Object],[object Object],[object Object]
Review ,[object Object],[object Object],[object Object],[object Object]

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RAC Audit

  • 1. Recovery Audit Contractors (RACs) Medicare. Medicaid and Commercial Insurance Investigations What you Need to Know
  • 2.
  • 3.
  • 4. Regions and timelines *RACs are required to perform outreach programs for all providers in their region From CMS D C B A March 1, 2009 March 1, 2009 March 1, 2009 March 1, 2009 March 1, 2009 March 1, 2009 August 1, 2009 August 1, 2009 August 1, 2009 Provider Outreach Claims Available for Analysis Earliest Correspondence
  • 5. How the RAC affect the Provider If the providers bill Fee-for-Service Medicare, Medicaid or Commercial Insurance programs, their claims will be subject to review by the investigators and auditors
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.