Recovery Audit Contractor

If you are a Medicare claims fee for company, you may already know of the RACs by now. A RAC is a Recovery Audit Contractor company, approved by Medicare claims to audit any and all fee for companies for inappropriate expenses. There are four RACs, each accountable for a area of the nation. They are individual from your regional Medicare claims company, so do not mix up a RAC audit with an audit from your regional company. They are two individual organizations. If you get a mail from a RAC informing you that you are being audited, it will be on their letterhead, not your regional carrier's.

RACs review Medicare claims statements registered by solutions on a post-payment base. There is a three year look back period, so they cannot review any claims mature than Oct 2007. The Facilities for Medicare claims and State health programs Services approve which problems the RACs are permitted to audit, and these accepted problems are required to be published to the RACs web page as public information. So at any time, a company may examine their area's RAC web page and see if any solutions they provide have been accepted for audit. The auditors use the same Medicare claims plans as providers, FIs and MACs. They are topic to all NCDs, LCDs, and CMS Guides. Each Recovery Audit Contractor company is also required to implement a team made up of the medical team, counselors, qualified programmers, and a doctor CMD.

There are two types of review: Computerized, in which no permanent medical history will be required from you. The RAC opinions these statements by an automatic computer formula. You should be able to recognize at which point you have been audited by the automated process. A remittance advice will be released with the review value N432: Modification based on Restoration Evaluation. Your regional company recoups the overpayment by balanced out on upcoming statements expenses unless you publish a examine or a real attraction.

The second type of review is complicated. This is where you will be approached with a ask for to deliver in medical information for the statements under review. There is a restrict to the number of information that the contractor can ask for every 45 days.