RACs
The facts on RACs
Three guinea pigs: California, Florida, and New York were the first three states to be audited by RACs. In 2007, it expanded to Massachusetts, South Carolina, and Arizona.
Show the government the money: The RACs corrected more than $1 billion of Medicare improper payments from 2005 through March 27, 2008. Roughly, 96% of the improper payments ($992.7 million) were overpayments collected from providers, while the remaining 4% ($37.8 million) were underpayments repaid to providers.
Cash motive: The contractors are paid on a contingency basis; they get a percentage of the money they recover.
Inpatient is No. 1: Of the overpayments, 85% were from inpatient hospital providers, 6% from inpatient rehabilitation facilities, and 4% from outpatient hospital providers.
No contest: Providers chose to appeal only 14%of the RAC decisions. Of all the RAC overpayment determinations, only 4.6% were overturned on appeal.
MSP flaws: $12.7 million was returned to the government through overpayments on Medicare Secondary Payer (MSP) RACs. $980 million came via claim RACs.
Coming to a hospital near you: The law states the national RAC program must be implemented by January 1, 2010.
Review period: The look-back period changed from four years to three years, and the maximum look-back date is now set as October 1, 2007.
We can help
Our team of experts can develop customized content to help train your groups no matter what your RAC need. Click here to 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:
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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.
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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.
