Oct

02

Q&A: RAC review

By The RAC Report

Question: If a provider has performed a self-audit prior to RAC review and wants to extrapolate these findings, will all these claims included in a self-audit be excluded from RAC review?

CMS’ answer: If a provider self-discloses a payment error and the Claims Processing Contractor confirms that a payment error exists and the sampling/extrapolation methodology used was correct, then these claims will not be reviewed by the RAC. The claims processing contractor will exclude the self-disclosed claims in the RAC data warehouse.

Source: Centers for Medicare & Medicaid Services