Leah Klusch - RAC Audit [Compatibility Mode]

RAC AuditLeah Klusch, RN, BSN, FACHCALeah KluschExecutive DirectorThe Alliance Training Center330-821-7616leahklusch@sbcglobal.netq Recovery Audit Contractor Programq 3 year, 3 state RAC demonstration program identified 1 billion dollars in improper claims over all healthcare providers reviewedq Demonstration focused on NY, CA, and FL but included providers in other states as wellq Permanent RAC program began in early 2009 to be in all states by January 2010q Goal to identify and recoup $10.8 billion in annual improper Medicare payments (GAO stats)1 " RAC AuditLeah Klusch, RN, BSN, FACHCAqThe RACs will detect and correct past improper payments so that CMS and the Carriers/FIs/MACs can implement actions that will prevent futureimproper payments.–Providers can avoid submitting claims that don t comply with Medicare rules–CMS can lower its error rate and payments–Taxpayers and future Medicare beneficiaries are protectedqMedicare Modernization Act, Section 306:–required 3-year RAC demonstrationqTax Relief and Healthcare Act of 2006, Section 302:–requires a permanent and nationwide RAC program by no later than 2010Both statutes gave CMS the authority to pay RACs on contingency fee basisq RACs review claims on a post payment basisq RACs use the same Medicare policies as FIs, Carriers and MACs –NCDs, LCDs & CMS manualsq Two types of review:–Automated (no medical record needed)–Complex (medical record required)q RACs will NOT be ...