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• RAC Auditors Sometimes Wrongly Denying New Patient Visit Claims
  A Pennsylvania Medical Society member recently informed us that the Medicare Recovery Audit Contractor for Pennsylvania was denying claims for new patient visits, simply because the patients had been seen in the same group under the same tax ID number within the past three years.
• Medicaid RAC Final Rule Addresses Many Earlier Concerns
  The final rule on Medicaid RACs, which implements Section 6411 of the Patient Protection and Affordable Care Act effective Jan. 1, 2012, means that physicians will have one more potential audit to worry about.
• RAC Reviews
  How will the RAC communicate with providers about the issues being reviewed; Will the RAC review claims paid by Medicare Advantage Plans; Can the RAC also review and initiate a recoupment previous claims?
• Discussion Period and Reviews
  If a provider opened a discussion with the RAC may he/she also file an appeal; Will the RAC accept missing or additional documents during the discussion period; Does the RAC appeal process mirror the Medicare appeal process?
• RAC Process
  How does the RAC plan to coordinate payment recoupment with the Medicare carrier; How many letters will a provider potentially receive from the RAC; Is the RAC permitted to extrapolate claim error results?
• Medicare Administrative Contractors to Issue RAC Demand Letters to Help Prevent Delays
  To help prevent delays in issuing demand letters, the responsibility for sending demand letters to providers is being transferred from Recovery Audit Contractors to Medicare Administrative Contractors beginning Jan. 3, 2012.
• RAC Program Expansion May Mean More Audits for Physicians
  The Centers for Medicare and Medicaid Services is expanding an auditing program to include Medicare Part C (Medicare Advantage plans), which may increase the administrative burden for physicians and the likelihood that your practice will be audited.

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