Expect RAC audit letters this month: Watch drug fees

Why This Topic Matters

RAC reviews can trigger documentation requests, repayment demands, and appeals activity, so practices need to understand the general scope of the program and where audit attention may concentrate. The article also highlights why changes in Medicare payment administration and prior claim adjustments can create confusion during review.

Article Sections

1. RAC program rollout and background

   Introduces Medicare’s recovery audit contractor program, its national structure, and the general role of contractors in claims review and recovery activity.

2. What RACs are looking for

   Summarizes the broad categories of claim issues and coverage concerns that may draw review, including examples discussed by CMS and oversight programs.

3. Expect your paperwork to increase

   Describes the anticipated volume of medical records requests and the administrative impact on practices of different sizes.

4. E/M services a target

   Covers the article’s discussion of physician evaluation and management review activity, documentation concerns, and the related response and appeal timelines.

5. Official resources

   Provides references to CMS and reporting resources mentioned in the article.