Navigating The Road To RAC Survival

In late August 2014, the Centers for Medicare and Medicaid Services (CMS) announced plans to reinstate the Recovery Audit program on a limited basis. CMS reports the delay in restarting the Recovery Audit program was to enable the various RAC regions to restructure, allowing time for the appeals to catch up. Soon, however, the hiatus will end and RACs in all regions will resume automated reviews; these will be in addition to select complex reviews based on topics chosen by CMS.

Start Preparing for Audits

The reinstatement of the program is limited to certain claims and does not include inpatient hospital patient status reviews during the commencement period. Currently, there is a statute prohibiting RACs from processing post-payment patient status reviews of inpatient hospital admissions through March 2015. After March 2015, RACs will be able to perform Patient Status Reviews; however, the volume of audits will remain low due to Medicare Audit Contractors’ (MAC) reviews.

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