BC Advantage - 2007 Issue 9
CMS' New Bounty Hunter Program - RAC ATTACK
Subscribe or sign in to view the full article.
Article Overview
This article explains the RAC demonstration project and its expansion from a small multi-state pilot toward broader nationwide implementation. It focuses on the administrative and compliance issues providers need to understand, including medical record requests, review and appeal workflows, repayment arrangements, and voluntary self-disclosure handling. It is aimed at hospitals, physicians, billing staff, compliance teams, and other providers preparing for RAC activity.
Why This Topic Matters
RAC audits can affect payment recovery, documentation workloads, appeal timelines, and internal coordination across multiple departments. The article helps readers understand the scope of the program and the types of operational planning needed to respond effectively.
Article Sections
-
Background
Introduces the RAC demonstration project, its early scope, and the broader policy context surrounding its expansion.
-
Key Issues
Summarizes the main program requirements and provider obligations discussed in the article, including the review process and related administrative procedures.
-
Request for Medical Records
Discusses the operational challenge of responding to medical record requests within the program's timelines.
-
Timely Filing
Addresses changes related to refiling certain denied inpatient claims and the claims-processing implications.
-
Review Process
Explains the RAC review workflow, documentation expectations, and the Medicare policy framework referenced in the review process.
-
Repayment Plans
Covers installment repayment options and the levels of review involved for longer repayment arrangements.
-
Voluntary Self Disclosures
Describes how provider self-disclosures are handled within the RAC framework and the administrative effects on recovery efforts.
-
Insights
Offers practical organizational preparation topics, including coordination, staffing, and process readiness for RAC activity.
-
Medical Records - RAC Readiness is critical and the time to start preparing for the RAC audits is now!
Focuses on internal preparation for handling record requests, assigning responsibilities, and coordinating communication.
-
Review Process - Do not simply accept the RAC's overpayment determinations and corresponding application of National Coverage Determinations (NDC) / Local Coverage Determinations (LCD).
Addresses provider review of determinations and the need to evaluate coverage and appeal-related issues promptly.
-
Summary
Reinforces the article's overall message about learning from demonstration-state experience and preparing for broader program adoption.
What You Will Learn
- How the RAC demonstration program was structured and why it was expanding
- What administrative issues arise when responding to RAC medical record requests
- Which general areas of the review, repayment, and disclosure processes are covered
- How provider organizations can prepare internally for RAC activity
Who Should Read This
- Hospitals
- Physicians
- Billing offices
- Compliance teams
- Denial management staff
- Utilization management staff
- Medical records departments
- Healthcare administrators
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com