Insights
Wracked by RACs?
on December 1, 2014
As written in the Long-Term Living Magazine, December 1, 2014
By, David E. Schweighoefer, Partner, Health Care Practice Group
Recovery audit contractors (RACs) recovered $3.75 billion in improper payments in fiscal year 2013. From that, more than $2 million was recovered from skilled nursing facilities (SNFs).
For many SNFs, it’s a matter of when, not if, the facility will be subject to an audit and subsequent recoupment activity. Owners and administrators have five things to consider:
1. Why were we chosen for an audit?
The RACs use a variety of data sources to determine audit targets, usually as a result of sophisticated data mining. Unusual patterns in claims using specific Current Procedural Terminology (CPT) codes, excessive claim submission for certain residents, excessive claims from certain providers and other sources of data all be may used to identify targets.
Click here to read the rest of the article.
By, David E. Schweighoefer, Partner, Health Care Practice Group
Recovery audit contractors (RACs) recovered $3.75 billion in improper payments in fiscal year 2013. From that, more than $2 million was recovered from skilled nursing facilities (SNFs).
For many SNFs, it’s a matter of when, not if, the facility will be subject to an audit and subsequent recoupment activity. Owners and administrators have five things to consider:
1. Why were we chosen for an audit?
The RACs use a variety of data sources to determine audit targets, usually as a result of sophisticated data mining. Unusual patterns in claims using specific Current Procedural Terminology (CPT) codes, excessive claim submission for certain residents, excessive claims from certain providers and other sources of data all be may used to identify targets.
Click here to read the rest of the article.
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