Return of the RACs – What You Need to Know About Recovery Audit Contractors

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As the nation forges ahead in the wake of the COVID-19 pandemic, programs like the Medicare Fee for Service (FFS) Recovery Audit Program have also restarted after a brief hiatus in March 2020 during the Public Health Emergency. Today, Recovery Audit Contractors (RACs) are back to business reviewing claims on a post-payment basis and while their goal is not to increase provider burden with audit responses, reductions in staffing have many hospitals scrambling.

Timeliness is crucial for CMS audit responses. Locating the corresponding medical records information can be a hassle and that’s why we have outlined a few key things your organization can do to better prepare for RAC audits:

  1. According to the Centers for Medicare & Medicaid Services (CMS), if selected for review, providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness. CMS notes that all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities will also be applied if they were in place on the dates of service for any claims potentially selected for review.
  2. Ensure that the RAC for your region has the appropriate contact information for requesting audit-related documentation. With so many changes to hospitals teams, it’s important to make sure that medical record requests the RAC is sending actually make it to the right person or team in a timely manner.
  3. Review the CMS website. Make note of the Approved and Proposed RAC Topics and ask questions about those you don’t fully understand.
  4. Provide internal audit review teams with proper access to data and other software tools like those used to ensure timely electronic audit responses. With a mix of teams working from home and in the office, it’s a good idea to make sure that teams handling Additional Documentation Requests (ADRs) and audit responses have necessary access to the data they will need to respond to requests.
  5. Review and document any changes to your audit review team processes.
  6. Meet with your teams to ensure that they fully understand the processes and are poised to respond within the required timeframes.

With proper preparation, the right tools and a team that understands the processes in place, audits can go more smoothly for both your hospital and the RAC. Ask us how Vyne Medical can help automate audit request and response workflows for your organization with the new Refyne™ platform*.

 

 

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