E/M Coding Alert - 2010 Issue 19
Recovery Audit Contractorst: RACs Can No Longer Keep Fees After Losing Appeals, CMS Says
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Article Overview
This article covers CMS guidance discussed during a RAC open door forum and focuses on the operations and oversight of Recovery Audit Contractors. It is relevant to providers, coding and compliance staff, and revenue cycle teams that follow Medicare audit activity, contractor review processes, and the public reporting of RAC findings. The article also addresses related questions about recoupment timing, interest charges, and how providers can obtain more information from RACs about issues under review.
Why This Topic Matters
RAC activity can affect payment recovery, compliance workflows, and administrative burden for Medicare-participating providers. Understanding the broad oversight changes and operational expectations described here can help organizations track audit-related developments and monitor potential exposure areas.
Article Sections
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CMS changes to RAC appeal fee retention
Discusses CMS policy changes shared during a RAC forum and the broader impact on appeal-related contingency fee handling.
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Staffing and validation requirements
Covers general staffing expectations for RACs, including review personnel and validation contractor oversight, along with public reporting of review accuracy.
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Public posting of RAC findings
Describes plans for posting major RAC findings online and the general purpose of making recurring audit trends visible to the public.
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Waiting for recoupment can cost you
Addresses provider questions about takebacks, timing of recoupment, and interest-related issues tied to contractor recovery processes.
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Questions about open issues and RAC communications
Explains how providers should respond when RAC inquiries do not match information shown on a contractor website and where to seek clarification.
What You Will Learn
- How CMS is adjusting oversight of Recovery Audit Contractors
- What general staffing and validation expectations apply to RAC review activity
- How RAC findings may be reported publicly in the future
- What provider questions arose about recoupment timing and related interest issues
- How to handle mismatches between RAC inquiries and posted open issues information
Who Should Read This
- Medical coders
- Compliance officers
- Revenue cycle managers
- Billing staff
- Healthcare providers
- Practice administrators
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