Expect More RAC Audits

Angie Szumlinski Announcements, News

In 2021, Medicare is celebrating its 55th year of providing health insurance to Americans. The program was first signed into law in 1965 and began offering coverage in 1966. That first year, 19 million Americans enrolled in Medicare for their healthcare coverage. As of 2019, more than 61 million Americans were enrolled in the program. President Biden is broadening the Patient Protection and Affordable Care Act (PPACA), Medicaid, and Medicare programs.

The RAC program was created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. RACs are responsible for identifying Medicare overpayments and underpayments, and for highlighting common billing errors, trends, and other Medicare payment issues. RACs are paid on a contingency fee basis, and therefore only receive payment when recovery is made. The RAC program is relatively low-cost and high-value for CMS. Telehealth audits will also be a focus with increased use of telehealth due to COVID comes increased risk of fraud.

Bottom line, be aware of your billing practices, consider performing an audit using an outside vendor, and include things such as medical, dental, and telehealth. You have an opportunity to increase revenue from government-paid services but with that comes increased risk. Know what your systems are, be vigilant in your corporate compliance efforts and stay the course, stay well, mask up, get vaccinated, and stay tuned!