Skilled Nursing Facilities Subject to RAC Audits
Our lawyers represent and counsel Skilled Nursing Facilities ("SNFs") in all aspects of healthcare law. The Recovery Audit Contractor ("RAC") program will be operating in numerous states this year, and will be nationwide by 2010. SNFs should prepare now for increased scrutiny of their Medicare claims.
Although it cannot be predicted with certainty the types of claims that will be subject to RAC scrutiny, reviewing the types of denials made during the RAC demonstration program is a helpful tool to identify potential target areas for the RACs operating in the permanent program.
During the RAC demonstration program, CMS identified over $16 million in alleged overpayments submitted by SNFs, which was nearly the same amount of overpayments the RACs identified submitted by physicians. The majority of denials made against claims submitted by SNFs were for the reasons that physical therapy, occupational therapy, and/or speech-language pathology services were medically unnecessary.
Other risk areas for SNFs include the following:
- Whether the Resource Utilization Groups ("RUGs") included on SNF claims for Medicare reimbursement are accurate and supported by the residents' medical records; and
- Medicare Part B services provided in nursing homes.
SNFs must prepare now for increased Medicare scrutiny of claims.
Wachler & Associates, P.C., has represented providers, suppliers and other healthcare entities subject to Medicare audits and claim denials for over 20 years. During the RAC demonstration program, our firm successfully represented numerous entities with their appeals of claim denials and overpayment determinations.
Publications
"The RACs are Coming - Are You Ready?" co-author Andrew B. Wachler, Esq., Member Briefing: American Health Lawyers Association Hospitals and Health Systems Practice Group, January 2009.
"RAC to the Future: What Can Medicare Providers and Suppliers Expect from the Recovery Audit Contractor Program?" co-author Andrew B. Wachler, Esq., The Health Lawyer, The ABA Health Law Section, Vol. 21, No. 2, December, 2008.
"The RACs Are Coming - Are You Ready?" co-author Andrew B. Wachler, Esq., The RAP Sheet, American Health Lawyers Association, Regulation, Accreditation and Payment Practice Group, December 2008.
"Recovery Audit Contractors and Medicare Audits: Successful Strategies for Preparing for and Defending Audits," co-author Andrew B. Wachler, Esq., Journal of Health Care Compliance, September-October, 2008.
"The Medicare Appeals Process and Strategies for Successful Appeals," co-author Andrew B. Wachler, Esq., American Health Lawyers Association, Physician Organizations, Vol. 10, Issue 1, Winter, 2007.
"Get Ready: The RACs May Be Nationwide Sooner Than Expected!" co-author Andrew B. Wachler, Esq., HCCA Compliance Today, 2007.
"The New Medicare Part A and Part B Appeals Process," co-author Andrew B. Wachler, Esq., Health Law Handbook 2006, Part I, Chapter I, 2006.
"The New Medicare Appeals Process," co-author Andrew B. Wachler, Esq., The Health Lawyer, The ABA Health Law Section, June 2005.
Speaking Engagements
"RACs: Appeals Strategies," Health Business Management Association (HBMA) 2009 Spring Education Conference, May 6, 2009 - May 8, 2009.
"RAC Audit Appeals- Strategies and Defenses for Overturning Hospital RAC Denials," National Healthcare Compliance Audio conference, May 5, 2009
"Ready or Not, Here They Come! Preparing for and Defending the RACS," (HCCA) 13th Annual Compliance Institute, April 26, 2009 - April 29, 2009.
"Advanced Appeals Workshop," 2009 American Health Lawyers Association (AHLA) Institute on Medicare and Medicaid Payment Issues, March 25, 2009 - March 27, 2009.
"The Basics: How the RAC Appeals Process Works," National Medicare RAC Summit, March 5, 2009 - March 6, 2009.
"Recovery Audit Contractors and Medicare Audits," 2009 American Bar Association (ABA) Emerging Issues Conference, February 18, 2009 - February 20, 2009.
"Managing the Recovery Audit Contractor Review Process," World Research Group, December 8, 2008 - December 9, 2008.
"Recovery Audit Contractors: Past, Present and the Future," 2008 ABA Health Care Law Section Washington Summit, November 17, 2008 - November 18, 2008 (with Melanie Combs-Dyer, senior technical adviser for CMS' division of recovery audit operations).
Contact Us
Call us at 877-403-6048 or send us an e-mail to schedule a meeting to discuss your concerns with RACs or to discuss your other healthcare law-related needs.
