RAC Audit Preparation, Education, Coding Review, Billing Review, Compliance

"Preliminary" RAC (Recovery Audit Contractor) Review

PRC IS NOT A RECOVERY AUDIT CONTRACTOR!

HOWEVER, PRC HAS BEEN ASSISTING HOSPITALS WITH MEDICARE COMPLIANCE AND REIMBURSEMENT SINCE 1979 AND WE CAN HELP YOUR FACILITY!

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RAC AUDIT FACTS
	The Tax Relief and Health Care Act of 2006 mandates the nationwide expansion of RAC audits to all states by 2010. These audits are intended to identify, and recover, incorrect payments by the Medicare Program. During the three year demonstration project in three states (NY, FL, CA), most overpayments (approximately 88%) were collected from Inpatient Hospital Services. Outpatient Hospital Services was the second largest area identified with overpayments (approximately 6%). Additional overpayments were also collected from categories such as, Physicians, Laboratory, and other suppliers. SOURCE: RAC Data Warehouse, CMS presentation at State Issues Forum on 1/24/08 Incorrect Coding was found to be the largest single category (42%) responsible for the improper payments. SOURCE: Self-reported by RAC's
	CURRENT NUMBERS REPORTED TO CONGRESS (FY2010) FY 2010 was the first year in which the Recovery Auditors began actively identifying and correcting improper payments under the National Recovery Audit program. All the Recovery Auditors began reviewing claims in October 2009. In the past fiscal year, the Recovery Auditors identified and corrected $92.3 million in combined overpayments and underpayments. Eighty-two percent of all Recovery Audit program corrections were collected overpayments, and 18 percent were identified underpayments that were refunded to providers.
	MAJOR OBJECTIVES OF A PRC RAC REVIEW
	PRC's RAC Review has been designed to identify potential areas of concern and recommend corrections (if necessary) to a hospital's Medicare reimbursement. The review encompasses various areas which are focused on by RAC Audits. While conducting the Review, we will evaluate the level of compliance, and if conducted on-site we will provide educational session(s) for your staff and/or physicians; CE credits may be awarded by their professional organizations for attending. A resolution session will be held at the end of the project, where all of our findings, errors, and discrepancies will be discussed, and our initial recommendations will be made. A comprehensive, written report will be submitted in a timely manner.

	KEY ELEMENTS OF A OUR RAC REVIEW
	Evaluate the clients Level of Risk from a RAC Audits Identify Coding errors and omissions Identify Billing errors and discrepancies Identify improper reimbursement Evaluate the Level of Documentation Provide Education to Staff Assist the client in Reaching Compliance and Accurate Reimbursement

JURISTICTIONS:

Under the program, the four RACs will contract with subcontractors to supplement their efforts.

The RAC in each jurisdiction is as follows:

Region A: Diversified Collection Services, Inc.

Region B: CGI Technologies and Solutions, Inc.

Region C: Connolly Consulting Associates, Inc.

Region D: HealthDataInsights, Inc.

Jurisdictions: