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RAC Audit Underpayments: Does CMS Owe You Money?

Author: Eramo, Lisa A

Source: Journal of AHIMA

Publication Date: February 2017



Anxiety—it’s the emotion that looms over most patient financial services (PFS) directors and those working in health information management (HIM) when they discover that their organization’s claims are subject to a Centers for Medicare and Medicaid Services (CMS) Recovery....

ABCs of Health Plan Audits

Author: Crump, Dawn; Hennum, Jeannie

Source: Journal of AHIMA - website

Publication Date: March 2015



The Affordable Care Act (ACA) has a dramatic ripple effect on the healthcare industry—and will continue to create seismic shifts for many years to come. One important change for health information management (HIM) professionals to understand is the impact of ACA on health plan audits. Alre....

Recovery Audit Program Changes

Author: Wilson, Donna D

Source: CodeWrite

Publication Date: February 2015



Editor's note: The Centers for Medicare and Medicaid Services (CMS) has delayed the commencement of work under the Recovery Audit contract for durable medical equipment (DME), home health (HH), and hospice reviews. For more information and further updates on this new development, please s....

Coping with Government Audits

Author: Butler, Mary

Source: Journal of AHIMA - website

Publication Date: August 2014





The HIM Problem: Medicare Auditor Scrutiny of Inpatient Claims


This spring, the Centers for Medicare and Medicaid Services (CMS) issued its “two midnight rule” which was intended to define and clarify what Medicare considers to be criteria justifying an inpatient st....

RAC Reform Awaits Government Action

Author: AHIMA Advocacy and Policy Team

Source: Journal of AHIMA

Publication Date: November 2013



Although the First session of the 113th Congress is coming to a close, plenty of work remains for the members of Congress to accomplish in the coming year. AHIMA has worked closely with federal legislators to raise awareness on key initiatives that affect health information management (HIM....

HIM Staff RACing Up Record Requests

Author: AHIMA

Source: Journal of AHIMA

Publication Date: April 2013


Healthcare claims auditors have inundated release of information staff and vendors this year with record requests, in part due to the aggressive Centers for Medicare and Medicaid Services’ (CMS) Recovery Audit Contractor (RAC) initiative. RACs review provider bills and medical records to....

Top RAC Target Areas

Author: AHIMA

Source: Journal of AHIMA

Publication Date: July 2012


If you bill fee-for-service programs, your claims will be subject to review by the Recovery Audit Contractor Program (RAC). That was the promise made by the Centers for Medicare and Medicaid Services when it expanded its once-experimental program to all 50 states in 2010. The RAC's mission....

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