Recover Audit Contractor Update

Recovery Audit Contractor audits continue to increase. The focus and issues vary by contractor so it is important to know who your contractor is, and to visit their website regularly for updated information on issues for review.

States are divided into four regions. The four contractors are:

  • Region A Diversified Collection Services, Inc.
  • Region B CGI Technologies and Solutions, Inc.
  • Region C Connolly Consulting Associates, Inc.
  • Region D Health Data Insights, Inc.

Links to the individual contractor websites can be found at: http://www.cms.gov/RAC/

The Patient Protection and Affordable Care Act (PPACA) expanded the program to include Medicaid and eventually Medicare Parts C and D programs.

One concern since the introduction of this program has been the number of records that RAC auditors were permitted to request. On February 14, 2011, the additional documentation request (ADR) was revised and limits the request to:

ADR limits will be based on the number of individual rendering physician/non-physician practitioner reported under each TIN/ZIP combination in the previous calendar year.

Maximum number of requests per 45 days

  • Group/Office Size:
  1. 50 or more – 50 records
  2. 25-49 – 40 records
  3. 6-24 – 25 records
  4. Less than 5 – 10 records

For additional information on RACs, request Corcoran Consulting Group’s FAQ on the RAC program.

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