New to the Midwest are Medicare Recovery Audit Contractors’ requests for your patient records.  The RAC program was authorized by Congress (Medicare Modernization Act of 2003) to identify improper Medicare payments – both overpayments and underpayments to hospitals.  Last year, the Medicare Recovery Audit Contractor Program moratorium Act of 2007 (H.R. 4105) was introduced in the House which would establish a one-year moratorium on the RAC program. No action has been taken yet on this bill.

The demonstration program was scheduled to end on March 27, 2008 for providers in CA, FL and NY.  In the Tax Relief and health Care Act of 2006 Congress authorized the expansion of the RAC program to all 50 states by 2010.  As Congress sometimes does, the horse was put before the cart.  The authorization for the expansion of the RAC program came before a complete or thorough evaluation of the problems and appropriateness of the program was made.  Of question and concern by hospitals are the payment incentives established for the RACs and the credentials of the staffed RACs (are they certified coding specialists or have another designation?). 

RACs are not permitted to review claims paid earlier than October 1, 2007 or claims that are more than three years pas the date that the claim was originally paid.  I’ve had contact with other members of The Association of Health Information Outsourcing Services

(AHIOS) and comments and recommendations from these members concerning these requests are to digitize the records sent to the RACs.  By digitizing the records, a quick access of the record can be made by the hospital when the claim goes for appeal. We can help you digitize these records.  For more information, you can contact your CMIS  account manager on how we can assist in this process of digitizing the records.

For more information about RACs go to:  www.cms.hhs.gov/RAC.