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Do RACs review claims paid by Medicare Advantage Managed Care plans?

Not yet. The RAC reviews are limited to claims paid under the traditional Medicare Fee-for-Service program until the program is expanded to Part C - Medicare Advantage, state Medicaid plans, and Part D - prescription drug plan claims. These programs must contract with RACs by the end of 2010 under the Patient Protection and Affordable Care Act.

Recovery Audit Contractors

RAC Scopes and Jurisdictions

Who is the RAC in my state?

Where can I learn what issues the RAC is reviewing?

Whose claims can be reviewed by the RAC?

Aren’t RACs focusing on hospital claims?

Do RACs review claims paid by Medicare Advantage Managed Care plans?

Do the RACs replace the other entities that review claims for accuracy of payment or investigate physicians' claims?

How far back can RACs look in reviewing claims?

Will RACs review claims for evaluation and management services?

RAC Review Criteria

How will RACs review claims for overpayments and underpayments?

What criteria will be used by the RACs in determining the medical necessity of services related to a claim?

RAC Recovery Requests

How can I identify a RAC recovery versus a request for refund from other sources?

If I disagree with an RAC's overpayment findings, can I appeal?

Is there limitation on recovery of small overpayments found by the RAC?

Medical Record Review by the RAC

Must I allow the RAC to conduct an on-site review of my medical records?

If the RAC requests copies of my patient records, will I be paid a fee for my expenses in providing the records?

When a RAC requests copies of patient records, how long does a physician have to comply with the request?

Is there a limit to the number of records that the RAC may request from a physician or group practice?

Planning to Avoid RAC Issues

What should I do to protect my practice from RAC recovery efforts?

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