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Recovery Audit Contractors (RACs):

What Behavioral Health Needs to Know

An Update for Hospitals Offering Psychiatric and Addiction Treatment Services

A two-hour training on compact disc

If you provide Medicare services, you need to understand and be prepared for reviews by Medicare Recovery Audit Contractors (RACs). The RAC demonstration program was authorized by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) as a way to find overpayments and underpayments in Medicare fee-for-service reimbursements to healthcare providers. What began as a demonstration program in 2005 in CA, FL, and NY (the states with the largest number of Medicare claims) expanded into MA, SC, and AZ in 2007. The demonstration program identified almost $1 billion in improper payments. Four permanent RAC contractors (assigned by geographic regions) have been named, and a national rollout plan is in place. All states are scheduled to be under the RAC program by 2010. The impact of this program has wide-ranging implications for all healthcare providers – including behavioral healthcare programs receiving Medicare funding. This telephone training features experts from the Centers for Medicare and Medicaid Services (CMS) and the American Hospital Association (AHA).  While provider education is currently being done by CMS and RAC contractors, this is your opportunity to ask the experts questions focused specifically on the concerns of behavioral health providers and to hear how RAC reviews are affecting your peers. Get a better understanding of what the system is intended to do, what specific steps RACs must follow, what your organization needs to do to be ready for RAC reviews, what claims may and may not be reviewed, what to anticipate in complex claims review, what review criteria the RAC will use, the overpayment/underpayment process, the appeals process, and what questions to ask along the way.

 

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