RAC Monitor: More Questions Than Answers

AAPC member John Paul Spencer, CPC, CPC-H recently authored an article for RACMonitor.com discussing additional document request (ADR) letter from a Recovery Audit Contractor and a disappearing frequently asked question from the CMS website.

“Q: I received an additional documentation request (ADR) letter from a Recovery Audit Contractor (RAC) for an issue that is not approved on their website. Do I need to submit the record?

A: RACs may request a small sample of records to assist CMS in determining if an audit concept is consistent with Medicare policy and should be approved for widespread review. Providers must still submit the requested documentation to the RAC within the expected time frame to avoid having that claim denied. The RAC will complete its review of the claim and issue a review results letter within 60 days.”

In order to determine that an issue should be added to an approved listing, a RAC has to first perform analytics, followed by establishing a reliable error rate,” he stated.

Read the full article here.

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