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.

Send us a query.

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:

• CMS report evaluating the three-year demonstration program
• Appeal update of demonstration program

• Observation status

  

  New guidelines on calculating time for observation, as well as difficult-to-understand coverage guidelines, make observation a perfect target for the new permanent RACs. Our experts will analyze the current regulatory environment related to observation status and help you determine the appropriate patient classification. Reimbursement dollars are at stake! Learn more about our December 12 audio conference.

• CPT 2009

  

  Do you have time to make sense of the hundreds of new CPT code changes for 2009? Our experts do. At the end of this live audio conference, your staff will be able to identify which sections of the 2009 CPT Manual saw the greatest number of revisions, demonstrate how and when to use the new CPT codes and explain the rationale for the changes. Learn more about our December 2 audio conference.