Recovery Audit Contractor Review

RAC audits pose one of the most difficult challenges faced by hospitals, physicians, and other healthcare providers over the past decade. The CMS concerted effort in the three demonstration states has identified over $300M in improper payments by Medicare.

Our first step in preparing your hospital for a potential RAC audit is to evaluate potential areas of risk proactively, considering existing medical documentation and coding practices.

We focus our review on those accounts that will be targeted by the federal government’s contingency-based RAC program, conduct a pro-active “RAC Readiness” audit of Inpatient and Outpatient coding, physician documentation, charge capture, and billing practices to determine a provider’s potential vulnerability to scrutiny, compliance risks, and financial recourse. Our consultant team has the expertise to assist in the areas of Inpatient, Inpatient Rehabilitation, and Outpatient services.

RAC services include:

Data Analysis
Account Selection
Medical Record and Billing Review
Identification of risk areas
Suggestions to prepare for an audit
Training and Education
Implementation of changes
Defense and appeal processing