E/M Coding Alert - 2005 Issue 18
RECOVERY AUDIT CONTRACTORS: Your E/M Visit Levels Are Safe From RAC Scrutiny
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Article Overview
This article explains the early CMS rollout of Medicare Recovery Audit Contractors (RACs) and the concerns raised by physicians and consultants about how the program would operate. It focuses on the general scope of RAC review, the types of claims activity CMS said would be prioritized, how provider correspondence and overpayment notices would be handled, and how the demonstration project was being communicated to providers. The piece is useful for physicians, billing staff, compliance teams, and coding professionals who wanted to understand the potential impact of RAC activity on Medicare claims processes.
Why This Topic Matters
RAC activity can affect claims review, documentation workflows, and provider appeals processes. Understanding the program’s stated scope helps providers anticipate audit exposure and prepare for Medicare correspondence without revealing substantive coding decisions.
Article Sections
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RAC program overview and CMS guidance
Introduces the Recovery Audit Contractors demonstration project and summarizes the CMS forum discussion about the program’s purpose and scope. Covers the general areas of claims review discussed by CMS and the role of Medicare rules in the process.
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Provider concerns about correspondence and claim review
Summarizes concerns raised by physicians and consultants about receiving RAC notices, contact information, and the practical handling of provider records. Also touches on questions about review staffing and the software used in the audit process.
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Implementation and communication details
Describes where the demonstration project was operating and how CMS said providers could learn more about the program. Includes general information about outreach methods and the handling of overpayment notices.
What You Will Learn
- How the RAC demonstration project was described by CMS
- What broad categories of Medicare claims activity were discussed in relation to RAC review
- What provider operational concerns were raised during the Open Door Forum
- How CMS said RAC correspondence and overpayment notices would be handled
- What general communication methods CMS used to publicize the program
Who Should Read This
- Physicians
- Medical office billing staff
- Coding professionals
- Compliance teams
- Revenue cycle managers
- Healthcare consultants
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