RAC Provider Audits and Why You Need to Worry

November 21, 2022
Medicare Advantage Plans

If you want to know what topics the Centers for Medicare and Medicaid Services (CMS) are auditing, you can find the list here.

Did you know that in 2019, CMS approved a “RAC topic” called 0129-Hyperbaric Oxygen Therapy for Diabetic Wounds: Medical Necessity and Documentation Requirements”?

That means in addition to all the other types of audits out there (e.g. Targeted Probe and Educate, etc.), the RAC is auditing hyperbaric oxygen therapy (HBOT) services. And did you know that the results of a RAC audit will almost surely be sent to your regional Medicare Administrative Contractor (MAC), ensuring that the fun will not stop with the RAC. Medicare post-payment audits are estimated to have risen over 900 percent over the last five years and the contractors get paid a percentage of the money they recuperate from you. That’s what is keeping Medicare afloat – payments flowing back into Medicare coffers. Wound and Hyperbaric centers represent a lot of that repayment to Medicare.

Healthcare attorney Knicole Emanuel’s blog is always a good source of information about Medicare and other types of audits (not specific to wound care or hyperbaric oxygen therapy). Her recent post about Recovery Audit Contractors (“RAC” auditors) is particularly interesting. Check it out here:

Questions Answered about RAC Provider Audits

Caroline Fife, MD

Dr. Fife is Co-Founder and Chief Medical Officer of Intellicure, Executive Director of the US Wound Registry, and Editor of Today’s Wound Clinic.

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