Medicare Recovery Audit Contractor (RAC) Program Has Begun
The Medicare Recovery Audit Contractor (RAC) program audits began in Massachusetts in February. Medicare’s goal is to identify improper fee-for-service payments, both overpayments and underpayments. To this end, Medicare has contracted with numerous companies to conduct post-payment reviews of billing data and medical record documentation to identify inappropriate Medicare payments. The audits will focus primarily on coding accuracy and medical necessity.
Audit Scope
All Medicare claims processed on or after Oct. 1, 2007, are available to the RAC for review. Going forward, the RAC will be able to review services for up to three years after a claim is processed. At this time, BWH is not aware of the specialties/services auditors will target or the potential volume of requests from the RAC program. However, it is likely that some of their reviews will result in a request to take back payment. BWH, however, has developed a comprehensive plan to ensure systems and processes are in place to receive, track and respond to RAC requests and denials and to provide information on targeted areas to the BWH community.
What We Need From You
Medicare has contracted companies to conduct post-payment reviews of billing data and medical records to identify these payments. BWH will be corresponding with Diversified Collection Services (DCS) and PRG-Schultz. Please instruct your teams to forward any misdirected correspondence from these companies to James Bryant, chief compliance officer, at 617-525-8534 as soon as possible.
If BWH receives a record request or a determination letter for services rendered by the hospital or a physician, that physician will be asked for assistance to substantiate the medical necessity of a claim.
If you have any questions or concerns regarding the RACs or their activies, please contact Bryant in Compliance at 617-525-8534 or jbryant3@partners.org