Washington DC RAC Information

Representing Medical Providers in the D.C. Area

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If you are a health care provider in the Washington, D.C., area, you likely have good reason to be concerned about the recovery audit contractor (RAC) program that is being conducted nationwide by the Centers for Medicare and Medicaid Services (CMS).

For the first time, there are private contractors, propelled by a clear profit motive, seeking evidence of overpayment to medical providers. This process can impose significant costs on providers, especially if an audit turns up alleged inconsistencies in your records.

At the law firm of Wachler & Associates, P.C., we are experienced at helping health care providers respond to and appeal payor audits, with a focus on cost containment. Contact us to discuss how we can help you deal with the impact of a RAC audit.

Serving clients in Washington, D.C., in Maryland and Virginia, and nationwide, our firm is exclusively devoted to health law.

Fully Prepared for the Growth of the RAC Program

All types of health care providers that claim compensation from Medicare are subject to audits by private contractors under the new RAC program. At Wachler & Associates, P.C., our attorneys are fully prepared to represent a wide range of clients, including the following:

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

During the demonstration stage of the RAC audit program, the overwhelming majority of funds collected by CMS on the basis of overpayment were collected from hospitals and health systems.

All medical providers in the Washington, D.C., region are equally subject to the program and have been facing RAC audits since August 1, 2009.

Guiding You Through the Appeals Process

If you are audited, the initial determination as to whether you have been overpaid will be made by the RAC, a private company that is compensated by CMS on a contingency fee basis. Diversified Collection Services, Inc., is currently the RAC for D.C. and Maryland, and Connolly Consulting Associates, Inc., is the RAC for Virginia.

After the initial determination, you will have the opportunity to appeal. There are several steps to the RAC appeals process, including redetermination, reconsideration, an administrative law judge (ALJ) hearing, a Medicare Appeals Council (MAC) review and a right of appeal in federal district court.

For help with your RAC audit, ZPIC audit, other Medicare audit or any type of medical payor audit from experienced lawyers with a track record of helping clients overcome health law challenges, don’t hesitate to contact us at Wachler & Associates, P.C.