Eli's Hospice Insider

Published on Mon Feb 01, 2010 PDF

See if you know the score for how RACs operate.

To find out if your RAC know-how is on the right track, answer the following questions:

1. The RACs are responsible for auditing which of the following (select one correct answer):

A. All types of Medicare claims, including those involving Part A, B, C (managed care) and Part D (pharmacy)

B. Medicare Part A and Part B fee-for-service claims only

C. Medicare Part Aand Part B and some Medicaid (where there is crossover between the two payers)

D. Medicare Part A and Part B and some third-party claims in states with Stark laws

2. The RACs perform automated reviews that involve data-mining and also complex reviews where they request a provider's medical records.

3. The RACs can request up to 200 records from a provider at a time regardless of its size.

4. The RACs focus primarily on detecting fraud and abuse, and work more closely with the HHS Office of Inspector General than any other auditors.

5. If a claim has already been reviewed by an intermediary, carrier, or another government auditor,the RAC can still audit it.

Editor's note: Find the correct answers to these questions on page 22.