Tampa Bay RAC Information

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If you are a health care provider located in Tampa, St. Petersburg, Clearwater or elsewhere in the Tampa Bay area, you are probably already aware of the Recovery Audit Contractor (RAC) program under which Medicare audits have been conducted for several years. But with the passing of the new health care reform legislation there have been a variety of changes, both in the administration and scope of the program.

In accordance with a federal law adopted in 2006, the RAC program has been expanded nationwide, and the process has changed somewhat to accommodate the lessons learned during the RAC demonstration program implemented in Florida and several other states.

At the law firm of Wachler & Associates, P.C. we have been carefully tracking the development of the RAC audit process and are fully prepared to provide skilled legal counsel to providers who want to proactively prepare for a RAC audit. If an audit has already begun or the provider receives an unfavorable audit determination, our experienced attorneys can develop an appeal strategy and help the provider navigate the Medicare appeals process.

Contact us to discuss your concerns about the RAC audit process with one of our knowledgeable health law attorneys. We serve clients not only in the Tampa Bay area, but nationwide.

The RAC program impacts all health care providers that serve Medicare recipients and bill CMS for these services. All of the following types of providers in the Tampa Bay area and throughout Florida are currently subject to RAC audits of their billing and medical records:

• Hospitals and health systems
• 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
• Skilled nursing facilities (SNFs)

If you have been audited, you have a right to legal representation throughout the audit and appeal process if you end up receiving an overpayment demand.

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 RAC for Region C, which includes the Tampa Bay area and the rest of Florida, is Connolly Healthcare. This private company is compensated for its RAC audit work on a contingency fee basis, meaning it will earn a percentage of all overpayments or underpayments it identifies. Based on data from the RAC demonstration period, overpayment determinations are expected to constitute the overwhelming majority of cases.

When you are going up against a CMS RAC contractor that is motivated to aggressively audit your records, you need a respected advocate with the experience to stand up for your interests throughout the audit process.

Our health care lawyers have a powerful record of successfully representing health care providers in Medicare audits and other third party payor audit cases. Our status within the health law community, as reflected in our publications and speaking engagements, as well as our involvement in professional organizations, allows us to aggressively seek the most beneficial outcome available to our clients.

You can rely on us to provide you with skilled legal counsel and aggressive representation through all stages of the RAC audit and appeal processes. Contact us to discuss what we can do to help you.