The RAC's are coming: Is your medical practice prepared?

Recovery Audit Contractors (RACs) Medicare, Medicaid and Commercial Insurance What you Need to Know Med-Billing Solutions, LLC

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Introduction Dedicated to serving the medical community Information Technology Terry Schladetzky Banking & Finance Alice Madrid-Neumann Real Estate Linda Brown Business Brokerage Robert Fiance Flagship Charity: "OwieBowWowie and Friends Foundation” Gina Gippner-Woods Joining us soon – Legal, Medical Waste, Construction and more… Marketing & Advertising Bob Charney Certified Public Acct. Kristine Vail Financial Services Edward Albrecht Medical Billing & Coding Stephen St. Gelais

Med-Billing Solutions, LLC Providers Coding Resource Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What is the RAC? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RAC Mission ,[object Object],[object Object]

Recovery Audit Contract-”RAC” ,[object Object],[object Object],[object Object],[object Object],[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

HealthDataInsights – RAC Auditor ,[object Object]

RAC contingency fee % ,[object Object],[object Object],[object Object],[object Object],Source: C MS http://www.cms.hhs.gov/RAC

How the RAC affects 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 Not at risk: practices/ facilities with high % (70%+) Medicare HMO Advantage, Medicare prescription

What about the other entities ,[object Object],[object Object],[object Object],[object Object],[object Object]

Private Insurance ,[object Object],[object Object],[object Object]

What does the RAC do? ,[object Object],[object Object],[object Object],[object Object]

Who Oversees the RAC? ,[object Object],[object Object],[object Object],[object Object],Source: C MS http://www.cms.hhs.gov/RAC

Evaluation and Management (E/M) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Importance of Documentation Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RAC Claims Audit Process Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Automated review ,[object Object],Detects clearly improper Payments (overpayment or underpayment determination) without evaluating the medical record associated with the claim. Source: C MS http://www.cms.hhs.gov/RAC

When the RAC arrives ,[object Object],[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]

Collection Process ,[object Object],[object Object],[object Object],[object Object],[object Object]

Key Timeframes (15, 30, 40, 120) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What to Expect Next ,[object Object]

How to Prepare Your Practice ,[object Object],[object Object],[object Object],[object Object]

MBS Support Base-Line Audit Process Medicare Documentation & Coding Benchmark Audit ,[object Object],Fax to HIPAA secure site (iDocumentsNow) 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]

Beyond the Base-Line Review ,[object Object],[object Object],[object Object],[object Object]

Review ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Services ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Complimentary Practice Analysis

Thank You ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Med-Billing Solutions, LLC Providers Coding Resource

The RAC's are coming: Is your medical practice prepared?

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