Question

Discuss how Recovery Audit Contractors (RAC) interact with Healthcare providers? How do RACs affect the Reimbursement for care providers?

Answer 1

Recovery Audit Contractors (RAC) detects as well as corrects all past improper payments. This enables Center for Medicare and Medicaid Services (CMS) to implement actions that will ensure that all future payments are improved. RACs interact with healthcare providers in an active manner so as to be enable providers to avoid submitting those claims that do not comply with the Medicare rules. This leads to lowering of error rates and hence increasing the efficiency of the entire process. The three key benefits as a result of interaction of RACs with healthcare providers are - minimization of provider burden, ensuring accuracy and maximization of transparency.

RACs affect reimbursement for care providers by making it necessary for care providers to know where previous improper payments have been found. The care providers will have to conduct an internal assessment to determine compliance with Medicare rules. Providers can improve reimbursement, going forward, by keeping track of denied claims, looking for patterns and putting in place corrective actions that will help them to avoid improper payments.