RAC Program

The Recovery Audit Contractor program from the Centers for Medicare & Medicaid Services authorizes RACs to identify and correct improper Medicare payments. Congress opted to implement RACs nationwide, and the program now is being introduced by region. Missouri is in the last group of states scheduled for RACs implementation in August. Given implementation delays, the RAC program likely will begin in Missouri later this year or possibly 2010.

MHA's RAC Activities
To estimate the effects of the RAC program for Missouri hospitals, MHA prepared a customized RAC report for each MHA member. Using inpatient discharge data from the Hospital Industry Data Institute, the report outlines the potential effects of the RAC program on inpatient discharges.

Presentations Available From Missouri RAC Seminar
CMS and HDI provided an educational RAC program for Missouri hospitals in August. Hospitals can view the following presentations and order a CD of the program.

• RACs and Medicare: The Who, What, When, Where, How and Why?
• Total Healthcare Claims Integrity, Quality and Cost Containment
• Order Complimentary CD — for Missouri hospitals only
  No Phone Orders Will Be Taken For The CD

RAC Appeals Process
CMS RAC Appeals Process for Medicare Parts A and B
AHA Member Calls -- Medicare Appeals

CMS Posts Transcript Of RAC Call
As previously reported in MHA Regulatory News, the Centers for Medicare & Medicaid Services recently hosted a conference call on Recovery Audit Contractors for Medicare Part A providers. A transcript of the call is now available. The transcript for the Part B conference call is not yet available.

RAC Advisories and Bulletins
AHA - RACTrac Brochure (3/1/10)
AHA - RAC Program Update (3/1/10)
AHA - RAC Program Update (1/11/10)
AHA - RAC Program Update (10/5/09)
AHA - Program Update
AHA - Coding Advisory
AHA - Permanent Program Basics
AHA - RAC Back on Schedule

RAC Presentations
AHA - Critical Access Hospitals
AHA - Short Stay, High Cost Procedures
CMS RAC Introduction
CMS Revised RAC Schedule
Health Data Insights - RAC Region D (Missouri is in Region D.)
RAC Overview

RAC Resources
American Hospital Association
The Centers for Medicare & Medicaid Services
HDI RAC Information

HDI Resources
Hospitals To Receive RAC Letters From HDI
Region D Recovery Audit Contractor HealthDataInsights informed Nevada hospitals that additional document request letters will be mailed this week to the contact names provided on HDI’s provider portal. If no contact information was provided, the letter will go to the address provided by the claims processing contractor. Medical record requests will be posted on HDI’s provider portal so providers can review them by next week. These routine requests are for DRG coding validation reviews; all new issues are posted to the provider portal. The Nevada Hospital Association shared a sample ADR letter with MHA.

MHA has been informed that, in Arizona, HDI is sending the Part A RAC letters to the hospital RAC designee. However, hospital chief financial officer are receiving RAC demand letters for Part B and durable medical equipment. If this happens in Missouri, the CFO should ensure that the hospital’s RAC contact is notified of any communications received from HDI.

RAC Questions
Please contact Gary Toliver if you have questions about the RAC program.

RAC Program Articles