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Have a RAC Question? CMS Has Some Answers

Andrea Kraynak, for HealthLeaders Media, June 11, 2009

While none of the newest Recovery Audit Contractor FAQs released by CMS—it published 15 in the last week—are particularly surprising, they are perhaps a sign that CMS is continuing to make every effort to share RAC information providers need to know through as many channels as possible.

It may be sharing the same information during RAC outreach sessions or during Open Door Forum calls, but now the information is also readily available to those who wish to learn about RACs in a Q&A format.

The new or updated questions include the following:

  • What is the reimbursement procedure and rate for photocopy charges associated with records for RAC audits?
  • How will the RACs determine which claims to review?
  • Whose claims will be reviewed under the RAC program?
  • Under what circumstances can a RAC, make a finding that an overpayment or underpayment exists without requesting medical records?
  • Under what circumstances will a RAC request medical records in order to determine if an overpayment exists.
  • How long does a provider have to submit medical records when requested by a RAC?
  • Do RACs look for underpayments? What happens if they find an underpaid claim?
  • How are the RACs paid for finding underpayments?
  • If a provider repays or Medicare recoups an alleged overpayment identified by the RAC and the provider later wins an appeal, will CMS reimburse the provider with interest?
  • Will the RAC review evaluation and management services on outpatient hospital claims?
  • Will the RACs replace all current review entities?
  • Will the timing for appeals by the Medicare contractors be the same for the RACs?
  • How are the RACs paid for finding and recovering overpayments?
  • Will the RAC appeal process mirror the regular Medicare appeal process?
  • How will the RACs choose the healthcare entity that is to be reviewed for over- or underpayments? Will it be a random process?

The entire list of questions is avaiable on the CMS Web site.

If you have a RAC question for CMS you have yet to have resolved, perhaps now is a good time to send in your question—CMS may just be in the mood to answer 15 more questions this week.


Andrea Kraynak, CPC, is senior managing editor of Medical Records Briefing and HIM Connection. She may be reached at akraynak@hcpro.com.


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