If your Medicare payments were audited, would you be ready? Health care providers offering Medicare services need be more diligent in their record-keeping and more attentive to coding than ever before. The Recovery Audit Contractor (RAC) program, which is designed to identify improper Medicare payments, recently became a permanent part of the landscape, and by December 31, 2010, the program will expand to include Medicare parts C and D.

Results from the Audits So Far

RAC auditors identified nearly $1 billion of overpayments in just 3 states during the three-year demo program. President Obama’s stated goal is to recover $2 billion over the next three years.

RAC Audit differ from Traditional Medicare Audits

RAC auditors are independent contractors, not government employees, so they have experience with data mining and could be reviewing a provider’s records without the provider knowing. If an overpayment is found, the provider is presumed guilty and the overpayment is recouped. The appeals process requires a timely and thorough documentation of services provided. The RAC auditors are paid on a contingency basis, so they are highly motivated to find mistakes.

By Cindy Padilla, Barnes Dennig

Contact Us to make sure you are ready.