Are you RAC ready?

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Monday, April 24, 2017

Since it’s been so long since HME providers have had to grapple with a RAC, stakeholders offered these pieces of advice:

Be proactive. “Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the impact of these audits for themselves.”

Read carefully. “Some are medical necessity reviews and some are documentation reviews,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “Pay attention to your audit request letters and know which you are dealing with.”

Keep organized. “Use separator sheets to tell the auditors, this is where the face-to-face evaluation is, this is where the proof of delivery is,” said Andrea Stark, a reimbursement consultant with MiraVista. “They’re going to itemize the things they want you to send back to them, so make it as easy as possible on them. It predisposes you to a favorable opinion.”