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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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.
