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Back in RACs

Let’s face it. RACs are viewed as problematic across all stakeholder audiences – even among the recovery auditors themselves as some RACs are talking about not renewing their contracts. Amazingly, this has many people questioning whether Recovery Audit program (RAC) will be back. These people point to the following facts:
  • CMS’ announcement that the RACs are officially paused:
    • Feb. 21, 2014 was the last day that a Recovery Auditor could send an Additional Documentation Request (ADR)
    • June 1 will be the last day a Recovery Auditor can send an improper payment file to the MACs for adjustment.
  • Numerous complaints & lawsuits filed about the Recovery Audit program by groups ranging from the American Hospital Association, to the Auditors themselves;
  • The backlog is more than two years before an Administrative Law Judge (ALJ) can possibly hear appeal cases.
Just because the RACs are paused, don’t let your compliance and audit preparedness slip! Claims submitted during the RAC pause still need to be compliant to avoid denials & audits. Whether the RACs resume; or throw in the towel; or even if a new program is introduced under a different name; hospitals and health systems still must prepare for an escalating volume of audits from both government and commercial payors. And, with the wide range of new payor plans in healthcare, each with their own set of rules, being proactive & prepared is quite a big job for hospitals. Tell us your thoughts.