Raleigh partner Matt Wolfe detailed what home health providers need to know about Medicare recovery audits audits during a webinar hosted by the Association for Home & Hospice Care of North Carolina. He covered:
- A brief background on the recovery audit contractors (RAC) for Region 5, as well as the overall scope of work and CMS expectations.
- How agencies can be chosen for an audit and types of audits, including automated and complex, and how notification works.
- ADR limits and how to send record requests, including what happens if records are not sent in.
- RAC guidelines.
- RAC automated and complex review work flows and important timelines, including how to utilize a discussion review and the appeal process.
- Role of the Medicare administrative contractor (MAC) in review and appeals.
- Risk of extrapolation and when to involve counsel.
- What you can do now to prepare.
Matt also wrote a blog recently explaining how a federal lawsuit over a massive Medicare appeals backlog is impacting RAC audits. You can find that blog post here.