”Recovery Audit Contractor” (RAC) is a term that every healthcare professional and staff member who deals with Medicare needs to know.
RACs were created as part of the CMS Medicare Integrity Program. Under this program, CMS is taking all possible steps to ensure that practices are submitting proper claims for reimbursement. The initial phase of CMS’ Medicare Integrity Program has been completed and is now operational in all 50 states.
Physicians aren’t likely to feel the full effects of the RAC for at least a year, but practices should start to take steps now to guard against audits. Here’s what you need to know:
- RACs are looking for improper payments, not fraud, but they will turn over obvious cases of fraud to the government;
- RACs will be able to audit E/M codes, but the American Medical Association is working with CMS to limit their reach in this area; and
- Rheumatology practices should perform regular self-reviews of coding and billing as part of their compliance plan. Practices should take the proper steps to correct any problems they find.
Regardless of how well you prepare and how honest you are, a RAC may still come your way. In some cases, they might simply find that your coding levels are higher than those of your peers because of the kind of work you do or the nature of your patient base. Just remember, the best defense is good documentation. If you would like to have the ACR coder review a sample of your charts for documentation guidelines, contact Melesia Tillman at mtillman@rheumatology.org or (404) 633-3777, ext 820.