Medicare RAC Audit Consulting

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In the Tax Relief and Health Care Act of 2006, Congress required a permanent and national RAC (Recovery Audit Contractor) program to be in place by January 1, 2010.

The goal of the RAC program is to identify improper payments made on claims for healthcare services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care providers submit claims that do not meet Medicare’s coding or medical necessity policies. Underpayments can occur when healthcare providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

Our healthcare group consultants have extensive first hand, detailed experience with the test New York state program. We can mitigate your exposure two ways, either: in advance of the audit; or assist after the audit with reducing required payments. The services we provide may include: Identification of risk areas; Quantification of exposures; Independent medical record review; Establishment of internal processes to show "in-control" status, i.e. a compliance program demonstrating active intent; and, Conducting RAC training sessions to prepare key personnel for the audits

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Related Industry: Healthcare