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Preparing for CMS Recovery Audit Contractors

Session #: 81537-xh
Presenter(s): Bobette Gustafson, Edward Hopkins
Session Length: 1hr. 40min.
Event: 2005 HFMA Audio Webcast
Date: 6-15-05

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CMS has selected Recovery Audit Contractors (RACs) to take part in a 3-year demonstration to determine the effectiveness of utilizing private companies, compensated on a contingent fee basis, in identifying and collecting Medicare overpayments. The RACs will be able to look for overpayments related to most Medicare Part A and Part B coverage and medical necessity issues going back four years. While the demonstration is limited to California, New York and Florida, the outcomes will heavily influence the CMS decision to expand the use of RACs to other geographical areas.

This audio webcast will preview the recovery audit process, and prepare Medicare provider and supplier representatives for greater payment scrutiny by:
* Reviewing the statutory authority and scope of the recovery audits, including the limitations on the RACs' authority;
* Recommending actions to take now in preparation for the recovery audits.
* Discussing the future impact of this demonstration project on the provider community

You will learn:
* The RACs participating in the demonstration and their recovery audit experience in health care and other industries.
* The broad scope of Medicare Parts A and B coverage and payment issues RACs are empowered to audit for all Medicare providers and suppliers, and which issues are off-limits.
* Practical steps to prepare for a RAC audit.
* How to contest RAC overpayment determinations, demands and collection efforts.
* What providers in states not included in the demonstration project should be doing today.



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