Recovery Audit Contractors and Medicare

Recovery Audit Contractors(RACs) and MedicareThe Who, What, When, Where, How and Why?1Agenda• What is a RAC?• Will the RACs affect me?• Why RACs?• What does a RAC do?• What are the providers’ options?• What can providers do to get ready?2What is a RAC?The RAC Program Mission• The RACs detect and correct past improperpayments so that CMS and Carriers, FIs, andMACs can implement actions that will preventfuture improper payments:• Providers can avoid submitting claims that donot comply with Medicare rules• CMS can lower its error rate• Taxpayers and future Medicare beneficiariesare protected3Will the RACs affect me?• Yes, if you bill fee-for-service programs, yourclaims will be subject to review by the RACs• If so, when?• The expansion schedule can be viewed atwww.cms.hhs.gov/rac4RAC Legislation• Medicare Modernization Act, Section 306Required the three year RAC demonstration• Tax Relief and Healthcare Act of 2006,Section 302Requires a permanent and nationwide RAC program byno later than 2010Both Statutes gave CMS the authority to pay the RACson a contingency fee basis.5What does a RAC do?The RAC Review Process• RACs review claims on a post-payment basis• RACs use the same Medicare policies as Carriers, FIsand MACs: NCDs, LCDs and CMS Manuals• Two types of review:Automated (no medical record needed)Complex (medical record required)• RACs will not be able to review claims paid prior toOctober 1, 2007RACs will be able to look ...