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Last Updated on:
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RAC's May Request Medical Records Beginning March 1, 2006 July
2006 Recovery Audit Contractors (RACs) may request a medical record for an underpayment determination beginning on or after March 1, 2006. RACs were authorized by section 306 of the Medicare Modernization Act of 2003 (MMA) (PubLNo 108-173) to (1) identify underpayments and overpayments, and (2) recoup overpayments. The request will not indicate if the medical record is being requested for an overpayment or underpayment review. If a RAC identifies an underpayment, the claim and all supporting documentation will be forwarded to the appropriate reimbursement contractor. If the contractor agrees that an underpayment was made, the RAC will send the provider written notice of the underpayment determination explaining that the provider may resubmit a corrected claim if the timely filing limit has not yet passed. RACs are reimbursed on a contingency basis and receive a portion of each underpayment or overpayment identified. |
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