Therapy Services: Get Ready for RAC Manual Reviews for Therapy Claims Over $3700

Why This Topic Matters

Therapy providers need to understand who will review higher-dollar claims, how documentation requests are routed, and what timing applies so they can manage compliance and cash flow expectations.

Article Sections

1. Understand the Pros and Cons

   This section discusses the policy shift to Recovery Audit Contractor involvement and summarizes perceived operational advantages and concerns. It provides context on how the change affects outpatient therapy claim oversight.

2. Determine Your State’s Review Status

   This section outlines how review type varies by state and explains the distinction between prepayment and post-payment review pathways. It identifies the states participating in the prepayment review demonstration.

3. Watch Your RAC’s Timeframes

   This section addresses the timeframes associated with review activity and the general pace of determinations under the new process. It highlights the operational timing expectations for providers.