RAC Audits coming to Medicare Advantage

RAC Audits coming to Medicare Advantage

Sara Beck

1/7/2016

Good morning,I found an interesting article concerning RAC audits.  In the article it details a Medicare announcement, issued after the holiday's, that RAC audits will soon be coming to Medicare Advantage plans.  Here is a quote from the article: The new audits could be comprehensive (examining a sample of all diagnoses codes) or focused on a few specific diagnoses. The agency also signals its intention to greatly increase the total number of audits. According to the statement of work, CMS anticipates going from 30 audits a year (about 5 percent of all MA plans) to having 'all MA contracts subject to' either a comprehensive or focused RAC audit.  It also states that it will be adding an appeals process to these plans, similar to the current Medicare appeals.  I wanted to pass this along so we can become prepared for this implementation.  It's important to treat all Medicare Advantage claims with the same scrutiny as regular Medicare claims.  If you need help with compliance, audits, appeals, insurance claims, etc.  please contact me.  I hope you all had a great holiday season.Best,Sara BeckLead Consultant Beck Consulting Company <URL Redacted>