By Denise Williams | News & Views

Ghosts and goblins are everywhere this time of year, but if you ever want to make a cardiac or pulmonary rehab professional’s skin crawl, just send RAC auditors knocking at their door. If you aren’t even sure what RAC audits are, that’s all the more reason you should check out the AACVPR webinar featuring Ginny Dow, RN, BSN, BC, CCRP, FAACVPR; Connie Paladenech, RRT, RCP, FAARC, FAACVPR; and Wayne Reynolds, RN, CCRP, FAACVPR. In the recorded presentation, the trio treats viewers to insights into the process and scares up some tricks for successful outcomes.

To avoid a frightful RAC experience, it’s important to understand what RAC is, where it came from and what it is trying to accomplish. The acronym stands for Recovery Audit Contractor, which is a standalone company that works on behalf of the Centers for Medicare and Medicaid Services (CMS) to retrospectively review fee-for-service claims. The RAC program was developed as part of the Medicare Modernization Act of 2003 but really started to grow teeth under the administration of former President Barack Obama, who in 2010 unveiled a campaign to reduce monies wasted on improper Medicare payments. It is the mission of RAC auditors to identify cases of incomplete or inadequate documentation, non-covered diagnoses, late or missing physician signatures on treatment plans, unintentional billing errors and other flaws; to then deny the associated claims; and to recoup the payment for Medicare. A simple missed deadline, meanwhile, could forfeit the right to appeal a denial.

If mishandled, RAC audits could generate thousands of dollars in unnecessary losses for CR and PR programs, which generally have narrow profit margins as it is. No one wants an audit sneaking up on them; but the prospect is much less menacing, the webinar presenters assure, when providers have a strong grasp of the process. Knowing what to expect and taking timely and appropriate steps throughout the process will curtail the likelihood of audit denials and improve the odds of successfully reversing denials.

To demonstrate, Dow, Paladenech and Reynolds dissect examples of RAC audits that were conducted in 2021 and 2022 – including what audit targets did right, and what they did wrong. They also mention various resources and tools that can support CR and PR programs as they work their way through an audit. The learning experience, free to AACVPR members and for a small fee to nonmembers, promises to take the spookiness out of audits and lay the foundation for favorable outcomes.

Click the link for access to the webinar recording of "RAC Audits: Tips and Tools to Prepare for Success."