MDS Alert
Knowing the Right Facts Can Put You a Step Ahead of the RACs
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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 A and 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 True or False: 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 SNF at a time regardless of the SNF's census. 4. The RACs focus primarily on detecting fraud and abuse, and work more closely with the Office of Inspector General than any other auditors. 5. If a claim has already been reviewed by the MAC or another government auditor, the RAC can still audit it. Editor's note: See the correct answers and rationale in the next issue of MDS Alert.
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