What triggers a RAC audit?

What triggers a RAC audit?

RAC audits are not one-time or intermittent reviews and can be triggered by anything from an innocent documentation error to outright fraud. They are part of a systematic and concurrent operating process that ensures compliance with Medicare’s clinical payment criteria, documentation and billing requirements.

What are RAC audits looking for?

The objective of this program is to discover any improper payments that are charged for uncovered services. These include services that are deemed “not reasonably necessary.” The RAC audits also focus on discrepancies such as fraud, duplicative services, wrong coding, and so on.

How do I prepare for a RAC audit?

Here are five ways you can prepare.

  1. Perform an Internal Audit. This action will help you to determine the likelihood of coding and billing mistakes within your company.
  2. Identify and Correct Coding/Billing Issues.
  3. Review Problem Areas.
  4. Check Documentation.
  5. Find Assistance.

How can RAC audits be prevented?

6 Critical Tips to Avoid RAC Audits

  1. Have a Risk-Management Plan in Place.
  2. Use Task and Employee Performance Checklists.
  3. Pay Attention to EHR Templates and Software Up-Coding.
  4. Avoid the Overuse of Levels 4 and 5 in E/M Codes.
  5. Control Errors and Expenses with an Independent Audit.

When did RAC audits start?

In 2005, CMS implemented the Medicare Recovery Audit Contractor (RAC) Program as a demonstration program for Medicare fee-for-service (FFS); Medicare Parts A and Part B. The pilot program successfully corrected more than $1.03 Billion in Medicare improper payments.

How far back can CMS audit?

Accordingly, CMS proposed legislation in the American Taxpayer Relief Act of 2012 to establish a period of five years from the first day of the year following the date of payment. The resulting statute is found at 42 U.S.C. § 1395gg(c).

How are RAC audits paid?

RACs are paid on a contingency fee basis, which means they are reimbursed based on a percentage of the improper payments they find or collect. The amount of the contingency fee is based on the amount of money from, or reimbursed to, providers.

How much does a RAC auditor make?

RAC Auditor Salary

Annual Salary Monthly Pay
Top Earners $125,000 $10,416
75th Percentile $87,000 $7,250
Average $71,261 $5,938
25th Percentile $56,000 $4,666

What is a RAC review?

RAC Review Process RACs review claims on a post-payment basis and will be able to look back three years from the date the claim was paid. There are two main types of review – automated (no medical record required) and complex (medical record required).

What is the RAC process?

First, the RAC identifies a risk pool of claims. Second, the RAC requests medical records from the provider. Once the records are received by the RAC, they will review the claim and medical records. Based on the review, the RAC will make a determination: overpayment, underpayment or correct payment.

What is a RAC audit in Medicare?

What does a Recovery Audit Contractor (RAC) do? RAC’s review claims on a post-payment basis. The RAC’s detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.

What is the difference between Mac and RAC?

MAC audits are powerful and intrusive procedures that have the potential to lead to serious federal charges for healthcare entities. A Recovery Audit Contractor (“RAC”) reviews claims and identifies overpayments from Medicare so that CMS and other auditors are able to prevent improper payments in the future.