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EHRs, RAC Audits & Coding: What providers need to know

Friday, November 16, 2012   (0 Comments)
Posted by: Joy Ingram
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by Adele Allison, National Director of Government Affiars, SuccessEHS


The Tax Relief and Health Care Act of 2006 (TRHCA) required CMS to implement a permanent national recovery Audit Contractor (EAC) program. The RAC program is intended to fight Medicare fraud, abuse and waste.  


A previous three-year demonstration project resulted in $992.7 million (gross) in overpayments ( $693.6 million in net returns) Under TRHCA, the permanent RAC program was launched on Jan. 1, 2010. On Sept. 1, 2012, the New York Times featured an article linking electronic health record (EHR) use to “up-coded” claims. On Sept. 24, 2012, U.S. Attorney General Holder and HHS Secretary Sebelius issued a letter warning of the use of “cloned” notes for inflated coding. On Nov. 1, 2012, the AHA and four hospitals filed suit against HHS over denied payments secondary to RAC audits.


This white paper contains:

  • Overview of the Provider RAC Program
  • Understanding the RAC Contractors
  • The RAC Audit Process
  • The RAC Audit Focus
  • Mitigating Risk and Use of Certified EHR Technology


Download the white paper with original graphs and charts here.

NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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