It is important to know the RAC assigned to your region. These audits are more complex than CERT audits. The majority of these, fortunately, do not find any error. The RAC system is deeply flawed. The contingency fee payment system encourages RACs to find error. RAC methodology can burden low-volume providers, as they tend to focus on technical mistakes rather than true wrongdoing.
The appeals process for RAC claims is complex, and you will need experienced legal counsel to navigate any appeal.
They compare your billing with similarly situated providers. They are authorized to suspend payments, determine overpayments, and refer providers for exclusion from government programs. Also, they provide direct support to fraud investigations conducted by the FBI and the Office of the Inspector General. ZPIC reviews are never random. They are performed under a presumption of fraud, and they often involve on-site inspections. They can be initiated by data analysis, high frequency of certain services, whistleblowers, or reports to various hotlines.
They may review a small number of patient records and, if they find error, extrapolate the data in order to determine the sum of misappropriated funds. They can even conduct interviews with your patients, beneficiaries, or employees.
Your employees have a distinct incentive to identify fraud through the whistleblower process because whistleblowers are eligible for a percentage of any recovered funds. Dealing with a ZPIC audit requires experienced legal counsel, as this is the audit with the highest level of scrutiny. RACs are paid through contingency fees. The more under- or over-payments they uncover, the more money they receive.
The payment for CERTs is different; they receive a set amount outlined in their contract, regardless of the percentage of payment errors they find. Size of the program. The CERTs examine random claim samples—often only looking at a very small percentage of a carrier's claims. Their responsibilities also include identifying and correcting underpayments and overpayments of these claims. The program developed by CMS, randomly audits claims monthly to determine if they were processed correctly.
The information is then used to determine the cause of errors and work to resolve them. Finally, the RAC program was created to identify improper Medicare payments. Offered as sector-specific individual certificates or a comprehensive dual certificate, the RAPS Online University certificates give you the knowledge and expertise you need to advance your career in just months combined with the self-paced flexibility of e-learning. Unlike the Regulatory Affairs Certification RAC , an exam in which one demonstrates their regulatory skill, there are no eligibility requirements or application deadlines for the RAPS Online University certificate programs.
The dual certificate offers you a way to explore different career path options available to a regulatory affairs professional, and provides you with comprehensive foundational knowledge across sectors.
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