RAC Audit

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I am currently going through my first RAC audit....has anyone ever been through this or have any info. that can help me. For years there was an inefficient biller who both billed and coded wrong in the office. She is now gone. However, her "billing" is being audited...and they are on 07' and 08' claims. We are being told 07' claims can be re-submitted correctly because of timely filing. What is the time frame in which an audit is usally audited on-1,2...3 years? As of today, the audit has now extended to BC/BS and RMSCO, Todays Options....we are very worried.
Any info. and help would be appreciated.
 

RebeccaWoodward*

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I am currently going through my first RAC audit....has anyone ever been through this or have any info. that can help me. For years there was an inefficient biller who both billed and coded wrong in the office. She is now gone. However, her "billing" is being audited...and they are on 07' and 08' claims. We are being told 07' claims can be re-submitted correctly because of timely filing. What is the time frame in which an audit is usally audited on-1,2...3 years? As of today, the audit has now extended to BC/BS and RMSCO, Todays Options....we are very worried.
Any info. and help would be appreciated.
1-How far back can RAC's look in reviewing claims?

RAC's are limited to a 3 year look back. This means that overpayments or records requests cannot be made more than 3 years following the date the claim was initially paid. The RAC program will begin with claims paid on or after October 1, 2007. This begin date will be for all states. The actual start date for a RAC in a state will not change this date. As time passes, the RAC may look back 3 years, but the claim paid date may never be earlier than October 1, 2007.

http://www.aafp.org/online/en/home/practicemgt/codingresources/recoveryauditcontractors/howfarbackcanracslook.html

2-Will the timing for appeals by the Medicare contractors be the same for the Recovery Audit Contractors (RAC)s?
Published 07/19/2006 01:54 PM | Updated 12/01/2010 10:59 AM | Answer ID 7737


Q-Will the timing for appeals by the Medicare contractors be the same for the Recovery Audit Contractors (RAC)s?

A-Yes. The timeframe for filing an appeal remains the same

http://questions.cms.hhs.gov/app/answers/detail/a_id/7737/p/8/session/L3NpZC9LWHhpWktpaw==

Information on timely filing:

70 - Time Limitations for Filing Provider Claims to Fiscal Intermediaries and Carriers

https://www.cms.gov/manuals/downloads/clm104c01.pdf

Last:

http://www.cms.gov/rac/

Just to clarify: You're being told that you can resubmit 2007 claims?
 
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