Mock RAC Audit


The Centers for Medicare & Medicaid Services (CMS) has initiated their Congress mandated Recovery Audit program. This program is aimed at identifying improper payments that were made by Medicare.  CMS has established a cap for the maximum amount of records that can be requested in this 45 day period.  This cap is based on the facility’s submitted Medicare claims regardless of the status of those claims in the year 2012.  Based on this calculation, each facility may have a different cap for claims that can be requested over the 45 day period. 

Potential Risks to Providers:

The Centers for Medicare & Medicaid Services (CMS) evaluation report shows that $693.6 million in improper Medicare payments was returned to the Medicare Trust Funds between 2005 and March 2008.  The funds returned to the Medicare Trust Funds occurred after taking into account the dollars repaid to health care providers, the money overturned on appeal and the costs of operating the RAC demonstration program. The results described in the evaluation report demonstrate that the RAC program is a needed and useful resource for detecting and correcting past improper payments. The RACs corrected over $1 billion of Medicare improper payments from 2005 through March 27, 2008.  Roughly 96 percent of the improper payments ($992.7 million) were overpayments collected from providers, while the remaining 4 percent ($37.8 million) were underpayments repaid to providers.

How can Harmony Healthcare International (HHI) help?

HHI sees a huge value in pro-active approach to revenue isolation. Based on HHI's expert knowledge of both denial management and Medicare guidelines, HHI has developed its own unique, comprehensive RAC Audit Tool that allows to:

  1. Predict what the results of an actual RAC Audit are likely to be

  2. Identify areas for facility to place its focus to maintain a compliance landscape

  3. Determine key educational opportunities and develop a facility specific “plan of correction”

HHI Mock RAC Audits are provided on-site where our consultants have a direct access to all medical documentation. 

Free Download! A Complete Guide to Successfully Avoiding Denied Claims