The ABCs of Health Plan Audits
Mar01

The ABCs of Health Plan Audits

By Dawn Crump, MA, SSBB, CHC, and Jeannie Hennum: Educating health information management professionals on the vernacular of payers can save time, hassle, and headache for both sides of the audit seesaw.

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Guidance on RACs

A new AHIMA toolkit helps HIM professionals steer their organizations through the Recovery Audit Contractor (RAC) program.  The “Recovery Audit Contractor (RAC) Toolkit” includes background on the program and an overview of the process, including what entities are eligible to be audited, the basis for the audits, and the type of audits. It also includes appendixes providing: A preparation checklist The hierarchy of authority samples A...

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CMS Settles RAC Protest, Reinstates Program

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that the parties involved in the protest over the award of Recovery Audit Contractor (RAC) contracts had come to a settlement. This means that the stop work order has been lifted, and CMS will continue with the implementation of the RAC program. PRG-Shultz will serve as a subcontractor to HealthDataInsights, Diversified Collection Services, and CGI Technologies...

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CMS Releases RAC Status Document

The Centers for Medicare and Medicaid (CMS) has reported on the status of the recovery audit contractor (RAC) program in Medicare for fiscal year 2007. In the report, CMS highlights improvements that will be made as it implements the permanent RAC program by 2010. The improvements include a set limit on the number of medical records that contractors may request. The RACs will be required to have certified coders and a medical director...

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