Audit Update: Get Ready for RACs to Scrutinize Your Critical Care, Global Surgical Claims

Why This Topic Matters

RAC audits can affect claim payments, documentation workload, appeal activity, and compliance risk for ED and surgical billing operations. Understanding the current audit focus and administrative rule changes helps organizations prepare internal processes and respond more effectively to review requests.

Article Sections

1. Heed RAC Hit List for EDs

   Summarizes the emergency department claim scenarios and compliance areas that have drawn RAC audit attention. The section also notes related issues cited for Medicaid RAC reviews.

2. Look for Changes in Additional Documentation Requests, Notification Timelines

   Describes CMS changes affecting additional documentation request limits, provider-specific review volume, and the handling of newer providers. It also addresses revised timing for notification of complex review findings.

3. No RAC Payment Until After the Second Level Of Appeal And RACs Must Maintain an Overturn Rate of Less Than Ten Percent

   Explains updated RAC performance standards tied to appeal outcomes and payment timing. The section discusses how CMS oversight may affect contractor review practices and corrective actions.