decisionhealth Newsletters, Part B News - 2009 Issue 4 (April)
CMS: Expect more RAC demand letters than record requests
Subscribe or sign in to view the full article.
Article Overview
This article covers the early rollout of the CMS Recovery Audit Contractor (RAC) program and what physician practices can expect from audit communications. It focuses on the difference between automated demand letters and complex review record requests, the timing of record submission and review, and the RAC discussion period that can be used before appeals. The article is relevant to physician practices, billing staff, coders, and compliance professionals who need to understand RAC workflow and audit response steps.
Why This Topic Matters
Understanding how RAC activity starts and how providers are notified helps practices prepare for audit correspondence, manage deadlines, and respond appropriately before a claim moves into appeals.
Article Sections
-
Early RAC program operations
Overview of how the permanent RAC program is expected to begin and the kinds of audit activity provider practices may see first. The section describes the general distinction between automated and more involved reviews.
-
Discussion period replaces rebuttal period
Explanation of the RAC discussion period and how CMS describes its role before the appeals process. The section also notes how the terminology differs from the earlier demonstration project.
-
Example involving physical therapy documentation review
A general example used to illustrate the type of concern that may be raised during the discussion period. The section emphasizes the broader workflow around complex review correspondence.
What You Will Learn
- How the early RAC program is expected to contact providers
- When record requests are more likely to occur in the RAC process
- What the RAC discussion period is intended to address
- How the discussion period differs from the earlier rebuttal period terminology
- What types of audit concerns may be raised before appeals begin
Who Should Read This
- Physician practices
- Medical coders
- Billing staff
- Compliance professionals
- Healthcare administrators
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com