Charlotte RAC Information

Advising Medicare Providers in Charlotte

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Medicare providers in Charlotte should be alert to the possibility of an audit from a Recovery Audit Contractor (RAC). The RAC program is effective nationwide and every Medicare provider is at risk of audit. The RAC for Region B, which includes North Carolina, is Connolly Consulting Associates, Inc.

Wachler & Associates, P.C. is an experienced health law firm that defends Medicare providers in RAC audits across the country. Our attorneys will guide you through the audit process and help you appeal any adverse audit determinations.

Strategy and Experience to Prepare for a RAC Audit

The Centers for Medicare and Medicaid Services (CMS) contracts with RACs to identify overpayments and underpayments to Medicare providers. The RACs are paid a contingency fee for the amount of money they recoup for CMS. As of date, underpayment claims have only been a small percentage of cases and there is no expectation that this will change. RACs will attempt to identify improper payments resulting from: erroneous payments, non-covered services, incorrectly coded services and duplicate services. This past September, CMS released its most recent RAC Statement of Work.

Although all Medicare providers should be attentive to the possibility of an audit, these providers should be particularly 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)

The health care reform act, the Patient Protection and Affordable Care Act (PPACA), ushers in additional expansion of the RAC program. 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.

Counsel With Local and Nationwide Experience to Guide Providers

Our experienced health care attorneys are available to assist our clients through all aspects of the RAC audit process. This process begins with preparing for a RAC audit and continues to appealing adverse audit determinations. The RAC appeals process has five steps. They are redetermination, reconsideration, an administrative law judge (ALJ) hearing, a Medicare Appeal Councils (MAC) review and an appeal in federal district court.

The team at Wachler & Associates, P.C. will examine your case with a focus on limiting your financial liability to CMS and a respect for your bottom line. We will advise you on the most effective strategies and execute your decisions with superb professional responsibility and proficiency.

Please contact us if you are interested in discussion how our firm can help you prepare, defend, or appeal a RAC audit. We also represent clients in other Medicare audits and all types of third party payor audits.