What is a RAC Audit?

RAC Audits, also known as Medicaid Audits, Medicare Audits, MAC Audits, or MIC Audits are ongoing, aggressive, intrusive programs with the sole purpose of recovering reimbursement from health care providers. These audits are expected to become more frequent for the foreseeable future.

Whatever type of audit is conducted, they pose a serious threat to your practice, finances, and reputation. These federally empowered auditing initiatives were set up to take back reimbursement from you and your practice

Compliance

The burden of compliance is the responsibility of healthcare providers. Outside of basic written guidelines, Medicare will not provide any specific guidance to the physician or provider.

Internal changes for practices should be established to monitor documentation and coding for compliance as well as establishing a framework for tracking RAC requests. These are not new requirements to providers. The provider application and contract clearly states that it is the sole responsibility of the physician to follow all documentation rules and regulations, coding and billing rules 100% of the time. Offices setting up compliance guidelines should appoint someone who will be responsible for monitoring compliance regulations. 

RAC Fees

RAC contracts fees are contingency-based, so auditors have every incentive to discover errors. RAC contingency fees vary and are established during contract negotiations with CMS.

Region A: 12.45% 

States: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

Region B: 12.50%

States: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin

Region C: 9.00%

States: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia  

Region D: 9.49% 

States: Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming 

Learn how to protect your practice from RACs.