RAC Audits Set to Kickoff in November
Knoxville Academy of Medicine Bulletin – October 2009
By Connie S. Ditto

As we all know, it’s football time in Tennessee.  As the tailgaters trek to East Tennessee, so do the Recovery Audit Contractors (RAC).  The RAC audits will be performed by companies that were awarded contracts by the Centers for Medicare and Medicaid Services (CMS) in return for a contingency fee based upon the amount of over (and under) payments the RAC collects.  Tennessee will be audited by Connolly Consulting, Inc., an auditor based out of Philadelphia, Pennsylvania.  Connolly Consulting is no stranger to audits, and in fact is the company that prides itself as the pioneer of data mining technology.

CMS and Connolly recently held an outreach program for Tennessee providers.  At this outreach, the representative for Connolly indicated that the auditing in Tennessee will begin in November 2009.  The issues available for audit by Connolly must first be approved by CMS, and are made available for review on Connolly’s website (www.connollyhealthcare.com/RAC).  The website will be updated as new issues are approved.  

The Recovery Audit Contractor program will increase the ability of Medicare to look back at previous payments in conjunction with the normal medical review process and the other auditing divisions such as Program Safeguard Contractors.  To illustrate the potential impact of this new type of audit, consider the overpayments collected in the demonstration project from just three states (New York, Florida and California) was in excess of $357 million dollars. 

Providers in Tennessee can prepare for a RAC audit by reviewing the list of issues to be audited on Connolly’s website and conducting an in-house review to identify any problem areas.  Further, there is no need to fall down in defeat if audited.  The appeals process for contesting the findings of a RAC audit are the same as for a Medicare audit, and providers may have insurance coverage to assist during an audit, such as attorneys fees associated with the appeals process.

Disclaimer: The information contained herein is strictly informational; it is not to be construed as legal advice.