What is the RAC process?

What is the RAC process?

First, the RAC identifies a risk pool of claims. Second, the RAC requests medical records from the provider. Once the records are received by the RAC, they will review the claim and medical records. Based on the review, the RAC will make a determination: overpayment, underpayment or correct payment.

What is a RAC request?

● RACs perform automated reviews when. improper payment is obvious. ● In the case of claims that are likely, to contain. errors, the RAC requests medical records from the provider to further review the claims (called a complex review).

What is RAC in medical records?

RAC is an acronym for recovery audit contractor. RAC represents an effort to audit health care providers on behalf of Medicare and Medicaid in order to identify improper payments made on claims of health care services provided to Medicare beneficiaries.

How often can RAC request records?

For example, RACs can only request 10% of the average monthly Medicare claims (maximum of 200) every 45 days in the following settings: Inpatient hospitals. Inpatient rehabilitation facilities. Skilled nursing facilities.

What is a RAC review?

The RAC works with Medicare beneficiaries to confirm the medical necessity and whether they received billed home health services or durable medical equipment. The RACs also review all claims paid to Medicare Part A and B providers to ensure compliance with Medicare’s statutory, regulatory and other policy requirements.

What does the RAC do?

Whether it is breakdown cover with roadside assistance, insurance, buying a new or used car, vehicle inspections and checks, legal services or up-to-the-minute traffic and travel information – the RAC offers a solution.

What is the purpose of RAC?

What does a Recovery Audit Contractor (RAC) do? RAC’s review claims on a post-payment basis. The RAC’s detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.

Can RAC audits be appealed?

All providers may appeal the initial determination made by the Recovery Audit Contractors, either informally or formally. The informal process involves appealing directly to the contractor within 15 days of receiving a notice to recoup an overpayment from the RAC.

How can RAC audits be prevented?

6 Critical Tips to Avoid RAC Audits

1. Have a Risk-Management Plan in Place.
2. Use Task and Employee Performance Checklists.
3. Pay Attention to EHR Templates and Software Up-Coding.
4. Avoid the Overuse of Levels 4 and 5 in E/M Codes.
5. Control Errors and Expenses with an Independent Audit.

How do I prepare for a RAC audit?

Here are five ways you can prepare.

1. Perform an Internal Audit. This action will help you to determine the likelihood of coding and billing mistakes within your company.
2. Identify and Correct Coding/Billing Issues.
3. Review Problem Areas.
4. Check Documentation.
5. Find Assistance.

What does RAC cover include?

It’s available for most vehicles, including cars, vans and motorbikes. And there are different levels of cover to choose from. Most providers only offer roadside assistance as standard. But at the RAC, we include roadside and home rescue, garage support and alternative transport with every cover level.