Medicare RAC Audits
Are you a healthcare provider undergoing a Medicare RAC audit? Discover the critical next steps you must take to avoid unnecessary costs.
Prepare for a RAC Audit
What you Need to Know
RAC Audit Assistance
Call Now: (310) 532-4555 | Email: sales@crossroadshealth.com
RAC Audit Next-Steps
Did you receive a letter like this from a RAC?
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.
RAC Auditors by Region
Call Now: (310) 532-4555 | Email: sales@crossroadshealth.com
Understanding The Risks
Credit Balances & The Associated Risk
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.
The Costs of a RAC Audit
Reduce Your
Financial Burden
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.
Request RAC Audit Review
Due to high demand, we are only handling a limited number of RAC Audits at this time. Please call or email and we will respond as quickly as possible.
Call Now: (310) 532-4555 | Email: sales@crossroadshealth.com
RAC Audit FAQs
Why was I chosen for a RAC Audit?
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.
How soon do I need to reply to a RAC Auditor?
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.
How do I prepare for a RAC Audit?
You should never ignore a letter from the RAC Auditor, however, there are a few things you can do prior to following their demands.
- Contact an expert, like Crossroads Health, who will walk you through the process step-by-step. Unlike RAC Auditors, Crossroads Health works for you, the healthcare provider.
- Shift human resources and put your best people on the task.
- Increase monitoring on your billing processes and attempt to identify the root cause of any issues. (Crossroads Healthdoes this on behalf of providers using proprietary software & specialized staff)
How far back do RAC Auditors look?
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.
What do RAC Auditors look for?
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.
How do I avoid future RAC Audits?
Consider taking proactive steps such as:
- Assess billing procedures to ensure compliance with Medicaid billing requirements.
- Resolving all Medicare and Medicaid credit balances within 60 days of payment.
- Determine if there are billing mistakes in their claim history that would trigger a CMS investigation
- Implement a process for responding to the RAC inquiries.
- Conduct a self-audit on a subset of claims to determine if they are in compliance with Medicaid requirements.
- Train organizational providers on proper documentation for code levels, and the need to be familiar and compliant with Medicaid billing requirements.