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Recovery Audit Contractor RAC Toolkit American Health Information Management Association 2009 AHIMA Page 1 of 65 Table of Contents Foreword. Appeals This section of the toolkit focuses on the appeal process specifically what needs to be included in a cover letter in the response who will submit the appeal letter and recommendations for where the letter s should be saved. Flow diagrams are provided to illustrate the appeal process and sample lette.

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Automated vs. The RACs will primarily conduct two types of audits: automated and complex. An automated review relies on an analysis of claims data to make a determination. Automated reviews are generally based on clear policies outlined in the law, regulations or guidance.

What does a Recovery Audit Contractor (RAC) do? RACs review claims on a post-payment basis. The RACs detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.

If your practice receives a RAC audit notification letter, it's generally to investigate suspicion of an improper payment on a claim (either an overpayment or an underpayment). RAC auditors will usually request medical records to complete the audit.

Some healthcare providers overbill or commit other fraudulent actions against the government institutions, and these audits are designed to flesh out such activities. RAC is an acronym for recovery audit contractor.

RAC is an acronym for recovery audit contractor.

5 Ways You Can Begin Preparing for a RAC Audit Perform an Internal Audit. ... Identify and Correct Coding/Billing Issues. ... Review Problem Areas. ... Check Documentation. ... Find Assistance. ... What does a RAC review during an audit? ... Who is selected for a RAC audit? ... What can cause an audit?

Audit Process: Steps and Responsibilities Step 1: The RAC Obtains Audit Scope and Documentation. ... Step 2: The RAC Reviews PDE record or other required data. ... Step 3: The RAC Issues Request for Information (if applicable) ... Step 4: The RAC Prepares Improper Payment Review Package (IPRP) ... Step 5: The DVC Performs Data Analysis.

Led by the Centers for Medicare & Medicaid Services (CMS), the goal of RAC audits is to identify and correct improper payments through the detection and collection of overpayments made on claims for healthcare services provided to Medicare beneficiaries.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232