A presentation explaining basic information about Recovery Audit Contractors (RACs) was published by The Centers for Medicare and Medicaid Services (CMS) on their website. The presentation describes RACs as a way to identify and resolve past improper payments, as well as provide reason to avoid future improper payments. Any entity that bills fee-for-service programs is […]
The Centers for Medicare and Medicaid Services (CMS) posted a new FAQ regarding Recovery Audit Contractors (RACs) on their website. The FAQ inquires what claim dates CMS uses to determine RAC medical record request limits for a fiscal year. CMS responded that they originally intended to use a designated calendar year’s claims to create limits […]
Recovery Audit Contractors (“RACs”), as other Medicare contractors, are authorized to audit only a small sample of a providers’ or suppliers’ records, and if the RACs find an overpayment, they will extrapolate the overpayment finding to the providers’ or suppliers’ patient population. If RACs engage in statistical sampling and extrapolation, RACs are entitled to keep […]
The Medicare Recovery Audit Contractor Program (“RAC”) program has been made permanent and is expanding nationwide, pursuant to Section 302 of the Tax Relief and Health Care Act of 2006. Medicare providers and suppliers in Michigan are some of the first in the country that will experience RAC audits and potential claim denials. Pursuant to […]
The Medicare Recovery Audit Contractor (“RAC”) program is being challenged by the two San Diego, California-based hospitals of Palomar Pomerado Health (“Palomar”). In a complaint filed against the Department of Health and Human Services (“HHS”) on March 27, 2009, Palomar alleged that PRG Schultz International, Inc. (“PRG Schultz”), the RAC operating in California during the […]
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