Jacksonville RAC Information

An Experienced Response to Audits of Medicare Providers

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Radiology providersIf you are a Medicare provider in Jacksonville and the surrounding area, you must be prepared for the possibility of an audit by a Recovery Audit Contractor (RAC). The RAC program was implemented by the Centers for Medicare and Medicaid Services (CMS) to audit the billing and medical records of Medicare providers.

At Wachler & Associates, P.C. we counsel health care providers across the country in RAC, ZPIC and other Medicare audits. Our attorneys solely practice health law and therefore understand the unique pressures on health care providers. If you are being audited, need to appeal the results of an audit, or wish to analyze your preparedness for an audit, please contact us to discuss how we can assist you.

An Effective Response to the Expansion of RAC Audits

The RAC program is now effective nationwide and our firm is attentive to continuing developments in the RAC program. The passage of the health care reform legislation has expanded the RAC program beyond Medicare Parts A and B. As of January 1, 2011, the program now applies to Medicare Parts C and D. Health care reform also expanded the RAC program to Medicaid and required each state to contract with a RAC by December 31, 2010.

Health care providers in Jacksonville and the surrounding area are now subject to audits by Connolly Consulting Associates, the RAC for Region C. RACs will attempt to identify improper payments resulting from: erroneous payments, non-covered services, incorrectly coded services and duplicate services. All Medicare providers should be prepared for the possibility of an audit, but the following provider types in particular should be alert:

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

RACs are paid on a contingency fee basis, earning a percentage of overpayments and underpayments they identify. Since underpayments have only represented a small percentage of cases, the focus of RAC audits under the permanent program is expected to continue to be on overpayments.

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.

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