Education and Diligence Are Key to Positive RAC Outcomes

The Recovery Audit Program Contractors (RAC) are back! On October 31, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the next round of RAC contracts have been awarded. Small enhancements have been made regarding look-back periods (three months versus three years) and review and notification timing (30 days versus 60 days). But, based on history, the program shows no discernable improvement in CMS oversight or contractor quality. What does that mean to you?

It basically means you are still in the same boat—a significant administrative burden to the practice. While we anticipate no shift in high overturn rates on appeal (as high as 80%), the substantial backlog in cases can create a cash flow and administrative nightmare for your organization and frustration for individual providers.

For most practices, the best defense against RAC is an effective offense. Provider and staff education on the requirements for correct documentation is a foundational first step. A compliance plan builds on this foundation and assists to establish a culture of compliance. A comprehensive plan should include regular external audits and education, in addition to internal coding and peer-to-peer reviews. The impartial eye of the external auditor can assess compliance with practice and CMS standards, while ongoing education can streamline compliant documentation and offer standardized templates to reenforce best practices to reduce the risk of negative audit outcomes.

Health Dimensions Group is committed to providing the highest quality coding and documentation education, auditing, and guidance on operational efficiency. Investment today in education can prevent catastrophic outcomes tomorrow. Contact Beth Carlson, EdD, RN, NHA, Director of Consulting Services, at 763.537.5700 or via email at for further

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Minneapolis, MN 55343