Philadelphia RAC Information

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All providers of service to Medicare beneficiaries will soon be aware, if they are not already, of the program CMS has enacted for determining over- and underpayments for Medicare services. A Recovery Audit Contractor (RAC), paid on a contingency fee basis, may audit providers’ billing records for all Medicare covered patients. While the RAC program previously only included audits of services billed to Medicare Parts A and B, the Patient Protection and Affordable Care Act (PPACA) has expanded RAC audits to include Medicare Parts C, and D as well.

Wachler & Associates, P.C. works with providers in Philadelphia and across the United States in all facets of the RAC process. Whether providers want to create a compliance program to minimize the likelihood of being selected for a RAC audit, to develop processes for responding to RAC audits, or need experienced counsel to defend an unfavorable audit, the attorneys at Wachler & Associates, P.C. can help.

Providers all across the health care spectrum should be prepared for a RAC audit if they are billing Medicare. All medical providers, including those listed below, should have processes in place for the efficient management and defense of audits by RACs, other Medicare contractors, or other third party payors:

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

Every medical provider that bills Medicare has the possibility of being audited by a RAC, which in Philadelphia, located in region A, is Diversified Collection Services.

Even though RACs are supposed to identify both underpayments and overpayments, contractors participating in the RAC demonstration program targeted overpayments the most. There is no indication that this practice will change as the RAC permanent program moves forward.

There are several levels of appeals available to those providers who receive an adverse audit determination. RAC audits have an appeals process that is identical to the appeals process used in other Medicare audits, with the addition of a “discussion period.”

Our attorneys have experience representing a myriad of healthcare providers in various health law related areas. In particular, we have years of experience when it comes to efficiently and effectively handling every aspect of Medicare, RAC and other third party payor audits.

We know that dealing with RAC audits, Medicare audits and other medical payor audits can be a difficult and stressful situation to handle in addition to the normal rigors of providing health care services. Our years of experience and knowledge can help providers to worry about the business of health care while we handle the appeals process.

For help dealing with a RAC audit, another Medicare audit or any other type of third party payor audit, or for information regarding implementation of compliance programs, please contact us at Wachler & Associates, P.C.