Miami RAC Information

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If you are a medical provider in Miami, Fort Lauderdale, West Palm Beach or elsewhere in South Florida, you may have some experience with the recovery audit contractor (RAC) process that was previously part of a local demonstration project. Now, RAC has been made permanent and expanded nationwide, and you need to be prepared in the long term for the possibility of audits.

At the law firm of Wachler & Associates, P.C., we are currently representing clients around the country who are being audited or have been audited by their local RACs. We already have extensive experience representing clients in Miami and throughout Florida during the demonstration period.

If you need legal representation during a RAC audit or appeal, don't hesitate to contact us to discuss your case with an experienced health law attorney.

Since March 1, 2009, health care providers in Miami and throughout Florida have been subject to RAC audits of their medical and billing records with respect to patients covered by Medicare. These audits are carried out by a private company, Connolly Consulting Associates, Inc., that is paid a contingency fee on all overpayments it identifies. (Underpayments are also covered but have so far been a small minority of cases.)

All types of medical providers are subject to the RAC audit procedure, including the following:

• Hospitals and health systems
• Skilled nursing facilities (SNFs)
• Radiology providers and independent diagnostic testing facilities (IDTFs)
• Ambulatory surgery centers (ASCs)
• Physicians and physician groups
• Hospice and home health agency (HHA) providers
• Durable medical equipment (DME) providers

Hospitals and health systems are expected to be the initial focus of the audit program, as they are responsible for a substantial portion of Medicare billing. However, other types of health care providers are far from being safe from audits and should be fully prepared for the possibility that overpayment claims will be made against them.

Providers should also be prepared for Zone Program Integrity Contractor (ZPIC) audits. ZPICs are CMS contractors that look for overpayments and potential fraud. For these audits, each state has been assigned to a different contractor. Florida is located in Zone 7 for ZPIC audits, with SafeGuard Services, LLC as its contractor.

The Centers for Medicare and Medicaid Services (CMS) has a lengthy appeals process for medical providers who receive adverse determinations. Certain aspects of this process will be different under the RAC audit process, while other aspects will remain the same.

Our lawyers are highly experienced with the federal administrative appeals process in general and knowledgeable in great depth about the new standards for RAC audit appeals, including changes that have been made since the initial demonstration period.

You can depend on us to accurately assess your case with an eye on cost containment and a respect for your bottom line. We will advise you on the best possible courses of action and implement your decisions with a high level of professional responsibility and competence.

Contact us to discuss the work we are doing in Miami, throughout Florida and nationwide to help hospitals, doctors and other health care providers respond to and appeal RAC audits, other Medicare audits and all types of medical payor audits.