RACs select the topics or areas they want to review which must be approved by CMS. Although most RAC audits have focused on institutional providers like hospitals, CMS indicates it is broadening RAC audits to include more provider types. Consequently, we can expect that RAC audits of physicians will increase.
Some things you should know about RAC audits:
- RACs are limited in the number of patient records they can request for complex reviews based on the size of the practice.
- Physician’s have 30 days to request a discussion with the RAC after being notified of audit results.
- RACs must confirm receipt of discussion request within 3 days.
- RACs are required to post – on their websites – the topic areas they will be auditing. You should be able to check to see if any are relevant to your practice.
- Look-back period is three years from date of payment for outpatient claims.
More information about RAC audits and a map showing RAC jurisdictions are on the CMS website.
- Region 1: MI; IN; OH; KY; NY; CT; RI; MA; ME; NH; VT.
- Region 2: MN; WI; IL; IA; MO; AR; MS; LA; TX; OK; KS; NE
- Region 3: TN; AL; GA; FL; SC; NC; VA; WV
- Region 4: ND; SD; WY; MT; ID; UT; AZ; CA; NV; OR; WA
CMS approved issues for each RAC can be found at the following:
Region 1: Issues under review
Regions 2 and 3: Who we serve – CMS approved issues
Region 4: New issues