The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program as a demonstration program to identify improper Medicare payments – both over payments and under payments. In early 2005 CMS announced that a three-year demonstration project aimed at three states (California, NY and Florida), where Recovery Audit Contractors (RAC’s) would begin the process of assisting CMS with identifying payment errors under the Medicare program. RAC’s can review the last four years of provider claims for the following types of services: hospital inpatient and outpatient care, skilled nursing facility care, physician care, ambulance and laboratory work.
FMQAI works closely with each individual client to customize a preparedness plan designed to create effective compliance guidelines while substantiating eligibility of payments. FMQAI’s experience with DRG coding guidelines, medical necessity assessments and unnecessary admissions enables us to look closely to find the root cause of medical claim errors. Through this analysis FMQAI is better able to clearly identify areas in process management, use of technology, or operational deficiencies which may lend themselves to the increased risk of errors. The outcome of the analysis is continually presented to the client with proposed solutions to improve operational efficiency and reduce the occurrence of future medical errors.
