{"id":882,"date":"2013-10-10T12:00:45","date_gmt":"2013-10-10T12:00:45","guid":{"rendered":"http:\/\/www.medicalbillingstar.com\/blog\/?p=882"},"modified":"2017-02-14T07:11:34","modified_gmt":"2017-02-14T07:11:34","slug":"infographics-rac-compliance-for-maximized-revenue-and-profit","status":"publish","type":"post","link":"https:\/\/www.medicalbillingstar.com\/blog\/infographics-rac-compliance-for-maximized-revenue-and-profit\/","title":{"rendered":"Infographics: RAC Compliance for Maximized Revenue and Profit"},"content":{"rendered":"

\"RAC<\/a><\/h2>\n

 <\/p>\n

RAC Audit Compliance \u2013 The Obligatory Conformity <\/b><\/span><\/h2>\n

The Recovery Auditor Contractor (RAC) program was initiated to identify and correct improper Medicare reimbursement payments<\/a> made to hospitals and clinics for claims for health care services provided to Medicare beneficiaries, and identification of underpayments to providers. There has been a meteoric increase in RAC activity ever since the program was initiated in 2008. The overall performance of the program has been satisfactory to some extent, as validated by the fact box :<\/p>\n

RAC Fact Box<\/b><\/span><\/h2>\n
    \n
  1. Recovery auditors detected $797 million in overpayments and $142 million in underpayments<\/strong>.<\/li>\n
  2. After taking all costs into consideration, underpayment determinations and appeal reversals – $488 million was returned to the Medicare trust funds.<\/li>\n
  3. RAC collections were highest in the following states: California ($143 million), New York ($45 million), Illinois ($43 million), Michigan ($39 million), Florida ($32 million) and Missouri ($31 million).<\/strong><\/li>\n<\/ol>\n

    The Modality<\/span><\/strong><\/h2>\n

    Recovery auditors employ a staff consisting of nurses, therapists, certified coders and a physician Certified Medical Dosimetrist (CMD). These auditors offer an opportunity for the healthcare provider to discuss improper payment determination. Issues reviewed by the auditor are approved by the CMS prior to widespread review. Approved issues are then posted to Recovery Audits Website.<\/p>\n

    Healthcare Providers\u2019 Burden<\/b><\/span><\/h2>\n

    Providers who agree with the Recovery Auditor\u2019s findings pay by cheque, allow recovery from future payments, or request for extended payment plan. They otherwise appeal if they don\u2019t agree.<\/p>\n

    Expert Tip to Avoid Penalty<\/b><\/span><\/h2>\n

    According to Dawn Crump, HealthPort’s Vice President of Audit Management Solutions<\/em>, “Audit Insights, hospitals and clinics must ensure that they are not billing for services<\/a> beyond those they deliver, ensure that correct higher E\/M levels are justified and reported, update themselves with RAC activity via the RAC websites, and shore up clinical documentation improvement (CDI) programs with an eye on known RAC targets and documented issues.”<\/p>\n

    Be Well-prepared for RACs to Avoid Embarrassment<\/b><\/span><\/h2>\n

    Some of the many precautionary RAC compliance measures are:<\/strong><\/p>\n