If so, call Crossroads Health before you do anything. The demands in this letter may not apply to your organization.
You should never ignore RAC Audit letters or CMS communications, but you should consider your options prior to responding. Crossroads Health will guide you through this complex process.
There may be massive risk hiding in your credit balances, potentially to the tune of millions of dollars in fines and penalties if out-of-compliance Medicare / Medicaid overpayments are discovered.
Even if you are being audited for a different reason, credit balances are often a point of interest during a RAC Audit.
Be prepared for your RAC audit with a team of credit balance experts from Crossroads Health backing you up. Our expert staff and proprietary technology makes the process a breeze.
If you have discovered delinquent Medicare credit balances, you are required to disclose them. However, healthcare providers often misidentify credits as out-of-compliance when, in fact, they may not be.
We’ve helped healthcare providers avoid hundreds of millions of dollars in CMS fines by applying our business intelligence to properly identify which credit balances are truly due a refund, and which are not.
*We typically find that only about 20% of credit balances are true overpayments.
It may not be any fault of your own. RACs use software to identify errors at the provider level. Basically, RACs data mine healthcare providers in their allotted territory looking for “red flags”; if they find any (or believe they could) they send a letter demanding that you provide more data.
Most RACs request a response within 30 days of receiving a notification. Before you respond, make sure you're prepared. If you are beyond the 30 day window, contact us for assistance.
You should never ignore a letter from the RAC Auditor, however, there are a few things you can do prior to following their demands.
RACs perform audit and recovery activities on a postpayment basis, and claims are reviewable up to three years from the date the claim was filed. They receive a contingency fee for both overpayments and underpayments they correct.
RAC auditors look for improper payments, meaning overpayments and/or underpayments; some of which carry a tremendous financial burden if not properly resolved. Particularly out-of-compliance Medicare/Medicaid credit balances, which can carry a $10k per credit, per day fine.
Consider taking proactive steps such as: