RACs
Recovery Audit Contractors
Over the past three years, CMS has administered a demonstration project in New York, California, and Florida, in which private contractors investigated improper payments from hospitals. Those contractors, who were paid a contingency fee based on recouped monies, identified more than $1 billion in improper payments since the program began. Of those:
- About $992 million were overpayments; the remainder were underpayments.
- 85% were collected from inpatient hospitals; 6% were from inpatient rehab facilities and 4% from outpatient hospitals.
- The top three reasons for overpayment were lack of medical necessity, improper coding and no or insufficient documentation on claims.
The RAC program was expanded into Arizona, Massachusetts and South Carolina in the summer of 2007, and CMS plans to roll it out nationwide no later than January 2010.
We can help
RACs are being deployed on an expedited rollout schedule. All areas of your facility can be at risk: facility E/M, surgical procedures, one-day stays and observation are all high on their radar. RAC will transcend all departments and must be treated as a direct assault upon your revenue. Your facility doesn’t have time to prepare. That’s where we come in. We can help you:
- Create an offensive approach to RACs
- Perform inter-departmental audits to identify potential risk areas
- Develop sustainable strategies to prevent future losses from improper payments
- Assist in ensuring appeals are appropriately managed
With all of the urgency and trepidation surrounding RACS, you need up-to-the minute information and a reliable authority to help you prepare and strategize as well as provide hands-on assistance in guiding them through the process.
We can also develop on-site customized education.
CMS resources
CMS announced contractors for the permanent program on Monday, October 6.
To read more from CMS, click here.
In addition, CMS released two reports evaluating the demonstration program. Click on the links below to read the reports:
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RAC Readiness
Despite a delay because of contractor protests, RACs are inevitable, and the burden now falls on your facility to protect your reimbursement dollars. Discover tips and strategies to combat denied claims. Learn what to expect when RAC comes to your state, how to track your RAC claim process, craft an appeals process, select your RAC team and avoid denials in the first place. Learn more about our January 6 audio conference.
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Injection and Infusion Coding and Billing
Many hospitals continue to struggle with reporting injection and infusion services accurately and completely. Issues such as reporting start and stop times, selecting the initial service, and dealing with Medically Unlikely Edits are just a few of the issues with which hospitals still struggle. Our speakers will share what they consider to be best practices for documenting infusion time, reporting drug administration services that cross the midnight hour, and charging for services in the inpatient and outpatient setting, among others. Learn more about our January 20 audio conference.
