San Diego RAC Information
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Health care providers in San Diego may already be familiar with the Recovery Audit Contractor (RAC) program. Effective now, the RAC program has expanded nationwide and will affect Medicare providers in San Diego and the surrounding area. With the passage of the health care reform legislation, the Patient Protection and Affordable Care Act (PPACA), RACs have expanded their audits as of January 1, 2011 to Medicare Parts C and D. In addition, health care reform expanded the RAC program to Medicaid. Each state was required to contract with a RAC by December 31, 2010.
The experienced health law firm of Wachler & Associates, P.C. has defended health care providers in RAC audits across the country. Our knowledgeable attorneys guide Medicare providers through the audit process. Contact us to discuss how we can help you respond to a RAC audit or to appeal an adverse determination.A Strategic Approach to Prepare for a RAC Audit
All types of health care providers are vulnerable to a RAC audit. In region D, which includes California, Health Data Insights is the RAC. RACs are selected by the Centers for Medicare and Medicaid (CMS) to identify overpayments and underpayments. The RACs are paid a contingency fee for the amount of money they recoup for CMS. All Medicare providers should be aware of the possibility of an audit, but these providers should be particularly 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)
Although hospitals and health systems are expected to be an integral focus of the audit program, all health care providers should be carefully attuned for the possibility of an overpayment claim. Recently the Government Accountability Office (GAO) recommended that CMS focus post-payment reviews on home health and durable medical equipment providers.
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. California is located in Zone 1 for ZPIC audits, with SafeGuard Services, LLC as its contractor.Experienced Health Law Counsel’s Guidance through the Audit Appeals Process
An essential component to success in the audit appeals process is effective legal counsel. There are five stages of the RAC appeals process including redetermination, reconsideration, an administrative law hearing (ALJ), a Medicare Appeals Council (MAC) review and an appeal in federal district court. Our attorneys are very experienced with this process. We will guide you through the most effective strategies to minimize your financial exposure and focus on the best course of action with high professional responsibility and competence.
Contact Wachler & Associates, P.C. to discuss how our legal team can help you in your preparation, defending, or appealing of a RAC audit. We also represent clients in other Medicare audits, such as ZPIC audits, and all types of third party payor audits.