Kansas City RAC Information

An Experienced Response to Audits of Medicare Providers

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If you are a Medicare provider in Kansas City and the surrounding area, you must be prepared for the possibility of an audit by a Recovery Audit Contractor (RAC). The RAC program was implemented by the Centers for Medicare and Medicaid Services (CMS) to audit the billing and medical records of Medicare providers.

At Wachler & Associates, P.C. we counsel health care providers across the country in RAC and other Medicare audits. Our attorneys solely practice health law and therefore understand the unique pressures on health care providers. If you are being audited, need to appeal the results of an audit, or wish to analyze your preparedness for an audit, please contact us to discuss how we can assist you.

An Effective Response to the Expansion of RAC Audits

The RAC program is now effective nationwide and our firm is attentive to continuing developments in the RAC program. The passage of the health care reform legislation will expand the RAC program beyond Medicare Parts A and B. As of January 1, 2011, the program has been expanded to Medicare Parts C and D. Health care reform also expanded the RAC program to Medicaid and required each state to contract with a RAC by December 31, 2010. CMS published its Medicaid RACs final rule on September 16, 2011, and which become effective January 1, 2012.

Health care providers in Kansas City and the surrounding area are now subject to audits by HealthDataInsights, Inc., the RAC for Region D. RACs will attempt to identify improper payments resulting from: erroneous payments, non-covered services, incorrectly coded services and duplicate services. All Medicare providers should be prepared for the possibility of an audit, but the following provider types in particular should be alert:

• Hospitals and health systems
• Skilled nursing facilities (SNFs)
• Durable medical equipment (DME) providers
• Hospice and home health agency (HHA) providers
• Physicians and physician groups
• Ambulatory surgery centers (ASCs)
• Radiology providers and independent diagnostic testing facilities (IDTFs)

RACs are paid on a contingency fee basis, earning a percentage of overpayments and underpayments they identify. Since underpayments have only represented a small percentage of cases, the focus of RAC audits under the permanent program is expected to continue to be on overpayments. This past September, CMS released its most recent RAC Statement of Work.

Guiding Clients through the RAC Appeals Process

Our experienced health law attorneys will guide you through appealing adverse RAC determinations. There are five stages in the RAC appeals process including redetermination, reconsideration, an administrative law judge (ALJ) hearing, a Medicare Appeals Council (MAC) review and an appeal in federal district court.

We are very experienced in guiding clients through the RAC appeals process and we are familiar with the most effective strategies to help minimize liability for repayment and the costs involved in enduring the appeals process.

If you are facing a RAC audit, another Medicare or any other type of third party payor audit in Kansas City, elsewhere in Missouri, or across the country, please contact us to speak with one of our health law attorneys.