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RAC Audit Process

Navigating a Recovery Audit Contractor (RAC) audit requires due diligence, as well as knowledge of laws and regulations if a health provider is to avoid being charged for overpayments that were erroneously assessed. Retaining qualified legal counsel is a critical part of the process. In fact, failure to leverage the knowledge of a qualified attorney can be costly. An attorney can also help you complete required documentation in accordance with best practices and a keen understanding of common pitfalls that should be avoided.

Some of the most common issues that exist with RAC audits is the provision of inaccurate or incomplete information. Another problem that occurs is a failure to submit responses in a timely manner. These are all mistakes that have proven to be detrimental to health care providers. As a result of recent governmental changes, there are a greater number of requests for overpayment in response to RAC audits. Appealing a ruling is no easy task because of ever-changing laws and regulations.

For a variety of reasons, it may be necessary to seek out assistance from a health care statistician if you have received a demand to return an overpayment. There might even be an opportunity to have a statistician serve as an expert witness if you appeal the RAC audit finding. Having an expert with knowledge of coding and billing can go a long way, especially if the payment is for a large sum.

Since RACs are private companies contracted by the Centers for Medicare and Medicaid Services (CMS), they are motivated to identify overpayments. While they might have good intentions, sometimes what’s uncovered isn’t necessarily accurate. Although the audits are for the purpose of detecting fraudulent activities, it’s worth noting that RACs are actually paid a percentage of the money they recover.

As with any business requirement that might be costly, due diligence is important. This couldn’t be more true as it relates to RAC audits, which is why securing counsel is so important. In fact, it should be a priority to contact an attorney the minute you receive notice of an audit. There is currently an increased amount of pressure for states to recover funds as a result of budgetary deficits. There are even some instances when an attempt to uncover fraud or recover overpayments from health providers results in audits that are inaccurate.

An RAC audit involves the use of formulas to determine if a claim paid for a particular procedure was allowed. The information obtained is extrapolated, which can result in a bill for overpayment exorbitantly high, yet based on inaccurate information. There are also significant fines associated with overpayment and the laws in some states require repayment to occur within 30 days. There’s also the possibility of having to pay additional fines for not submitting the right documentation.

In the event that the RAC audit is incorrect, there is an administrative hearing that gives you a chance to prove that no errors were made in the initial application of the funds. This hearing enables you to demonstrate that you were in fact entitled to the amount billed and received. A qualified attorney will have the knowledge and expertise to navigate the hearing, while ensuring adherence to all requirements.

It’s more common than not for audits to result in a provider being assessed a significant amount of money in overpayments. This is why the appeals process is likely to be necessary. Having counsel engaged from the beginning is the best way to protect your practice. An attorney will have the knowledge and expertise needed to secure the best possible outcome.

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Charle Butler
Charle Butler
2021-03-12
Verified
I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
Mesonista parsons
Mesonista parsons
2021-03-05
Verified
My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
debabrata chakraborty
debabrata chakraborty
2021-03-03
Verified
Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
Asata Hendricks
Asata Hendricks
2021-03-02
Verified
Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
Mike Moroff
Mike Moroff
2021-02-26
Verified
I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
2021-02-24
Verified
Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
L.C.
L.C.
2021-02-24
Verified
I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
2021-02-23
Verified
I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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"Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them..."

David Bruce

"Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet."

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"Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind."

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