underpayments to providers , and to provide information that allows CMS to implement actions that will prevent future improper payments .
CMS has identified five key factors for measuring the success of the Recovery Audit Program : increasing accuracy , implementing effective and efficient program operations , maximizing transparency , minimizing provider burden , and developing robust provider education . In addition , communication with key stakeholders is essential to the program ’ s success , as it seeks to identify problems and develop solutions early and to discuss those issues with all parties . CMS has named four national Recovery Audit Contractors ( RAC ) to audit Medicare fee-for-service providers . Providers should know who the RAC is in their region and take the RAC mission seriously .
Once a practice is engaged in a RAC audit , CMS will send a detailed request for medical records for a population of claims . Providers do not need to redact the records as the RAC ’ s are operating within the scope of CMS and are authorized to view this information . The records must be delivered to the RAC within 45 days . A request may ask for one specific record or multiple records . It ’ s critical that the record is photocopied in its entirety for the RAC , as incomplete records could result in additional findings of insufficient documentation .
For more information on the Recovery Audit Program , visit the “ Recovery Audit Program ” Web page at go . cms . gov / RAC .
Some of the issues affecting providers are as follows :
• Short-stay inpatient visits
• “ Incident to ” services provided by non-physician practitioners
• Unbundling of procedures
• Medical necessity
• Units of service
• Therapy services ( e . g . Occupational Therapy , Physical Therapy , Speech Language Pathology )
• Skilled nursing facilities
• Home health agencies
• Part B hospital inpatient services when a Part A inpatient admission is denied as not reasonable and necessary
• Prior authorization of power mobility devices
87