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Medicare Compliance & Reimbursement

RAC AUDITS :

Follow These 6 Steps to Prepare for RAC Audits

Published on Mon Apr 20, 2009

Take requests for documents seriously and verify that your documentation is solid at all times. RAC medical review bounty hunters are rolling out in 24 states now and will start activities in the remaining states in August. In their three-year pilot, RACs racked up a whopping $1 billion in corrected overpayments. If your organization shows up on a RAC hit list, you can expect a big claims review hassle. RACs work on a contingency fee basis, meaning they receive a portion of the amount -- from 9 to 12.5 percent depending on the contractor -- that they deny or downcode. "Our results demonstrate that 10 percent to 15 percent of the providers represent 80 percent to 90 percent of the overpayments," says Region D RAC Health Data-Insights on its Web site. Safeguards: But unlike in the RAC pilot, CMS is limiting how many records the RACs can review. Audits are limited to [...]
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