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

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.

• 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