Jackson Davis HealthCare, a consulting group specializing in RAC audits and appeals, lists three ways RAC audits differ from the traditional Medicare audit process used by Medicare Cost Reports and QIO medical review probes.
1. Shared savings approach. "CMS is banking on financial incentives to motivate the independent RAC auditors, unlike their previous QIO counterparts," Jackson Davis writes. The agency is paying RACs about 10 percent of every dollar recouped in perceived overpayments.
2. More sophisticated IT. RACs are expected to build an automated IT infrastructure that allows for ongoing, overpayment determinations and denials for individual healthcare providers on a perpetual basis.
3. Constant reviewing. RAC audits are not one-time or intermittent reviews. "They are a systematic and concurrent operating process for insuring compliance with Medicare's clinical payment criteria, documentation and billing requirements," Jackson Davis writes.
Read the full report on the website of Jackson Davis.
Read more on RAC audits:
-Medicare RACs' Most Recently Posted Approved Issues
-10 Best Practices for Hospitals to Prepare for, Respond to Recovery Audit Contractors
-AHA’s RACTrac Survey Finds Medical Record Requests Most Popular RAC Activity
1. Shared savings approach. "CMS is banking on financial incentives to motivate the independent RAC auditors, unlike their previous QIO counterparts," Jackson Davis writes. The agency is paying RACs about 10 percent of every dollar recouped in perceived overpayments.
2. More sophisticated IT. RACs are expected to build an automated IT infrastructure that allows for ongoing, overpayment determinations and denials for individual healthcare providers on a perpetual basis.
3. Constant reviewing. RAC audits are not one-time or intermittent reviews. "They are a systematic and concurrent operating process for insuring compliance with Medicare's clinical payment criteria, documentation and billing requirements," Jackson Davis writes.
Read the full report on the website of Jackson Davis.
Read more on RAC audits:
-Medicare RACs' Most Recently Posted Approved Issues
-10 Best Practices for Hospitals to Prepare for, Respond to Recovery Audit Contractors
-AHA’s RACTrac Survey Finds Medical Record Requests Most Popular RAC Activity