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Written by: Darlene D'Altorio-Jones (1959-2015) on Thursday, December 20, 2012 Posted in: Inpatient Rehab

CMS has heard them too!  So many myths in fact that they just published a document on December 18 called, RAC Program Myths. It was put together in a very familiar question and answer type format.

I’ve heard a few of these myths and have blogged on several of these topics; perhaps you want the real answer.  I encourage you to review the list below and start TALKING! Let these facts be part of your conversation this week!

Here are the list of MYTHS I am sure you want the real answers to:

  • Myth: RACs deny every claim that they review
  • Myth: RACs have a contingency fee between 30 and 50 percent
  • Myth: Every RAC denial is overturned on appeal
  • Myth: RACs have non-clinicians conduct review of medical records
  • Myth: RACs create their own policies and are not bound by CMS regulations, NCDs or LCDs
  • Myth: RACs can review as many claims as they want from a provider
  • Myth: RACs don’t have physicians on staff
  • Myth: RACs are focusing complex reviews on Critical Access Hospital claims
  • Myth: RACs do not tell anyone what they are reviewing
  • Myth: RACs do not issues detailed result letters
  • Myth: RACs do not issue timely denial letters
  • Myth: RACs outsource all the medical review to staff in India and the Philippines
  • Myth: RACs deny IRF (inpatient rehab facility) claims because the care could have been given in a less intensive setting
  • Myth: RACs target providers who are part of CMS demonstrations

The references to support the answers provided to these myths are the Statement of Work for Recovery Audit Programs and the Implementation Document as part of a 2010 Report to Congress.