The Centers for Medicare & Medicaid Services (CMS) has made the intensive Medicare Recovery Audit Contractor (RAC) Program permanent. Previously a demonstration project, CMS is expanding the RAC Program to all 50 states. The RAC Program uses private contractors to audit health care providers in search of inappropriate Medicare payments. These contractors will be eager to find inappropriate payments because they are paid on a contingency basis based solely upon the improper payments they identify and recover. As a result, health care providers, including physicians and hospitals, must be well prepared to respond to an intensive RAC audit.
Providers who are prepared for RAC audits will spend less money responding to audit requests, will be better positioned to challenge questionable determinations, will be prepared to file timely appeals and will encounter less overall disruption to their day-to-day operations.
Experienced Professionals
Knowing that RAC audits are complex and have strict deadlines, Baker & Daniels has assembled a team of experienced professionals to help clients respond to RAC audits. This team includes:
- A Certified Professional Coder ready to conduct internal audits of the data and medical records subject to the RAC audits;
- Former health care practitioners who understand the internal operations of hospitals and physician practices;
- Health care attorneys who can assist providers in assembling their RAC responses and address any legal issues that arise during the audits, including Anti-Kickback and Stark issues;
- Litigators, including a former Assistant U.S. Attorney responsible for health care fraud enforcement, who is ready to help evaluate whether a RAC auditor's allegations should be appealed and to file those appeals; and
- White Collar criminal defense attorneys who can address any serious legal issues that may arise during or after a RAC audit.
How We Can Help
The Baker & Daniels RAC Audit team can work quickly and efficiently to assist health care providers subject to a RAC audit by:
- Helping providers assemble their own internal RAC audit response teams;
- Assisting providers in their interactions with RAC auditors;
- Counseling providers on preparing a response to RAC audit requests that will provide a strong foundation for any subsequent appeal;
- Conducting an internal audit to identify medical record and payment problems before the RAC audit;
- Conducting RAC training sessions to prepare key personnel for the RAC audits; and
- Appealing any determination of an improper payment by a RAC auditor.
To learn more about the Recovery Audit Contractor (RAC) Program, click here.
To visit the CMS Web site on the Recovery Audit Contractor (RAC) Program, click here.