Now that you know which Medicare Recovery Audit Contractor (RAC) will come to your facility, it’s time to prepare for some changes. CMS revamped the program after the three-year demonstration project, and providers can expect to see the changes reflected in the nationwide permanent program.

Chief among them are:

RAC medical director

Demonstration RACs: Not required

Permanent RACs: Mandatory

Coding experts

Demonstration RACs: Optional

Permanent RACs: Mandatory

Credentials of reviewers provided upon request

Demonstration RACs: Not required

Permanent RACs: Mandatory

Discussion with CMD regarding claim denials if requested

Demonstration RACs: Not required

Permanent RACs: Mandatory

AC validation process

Demonstration RACs: Optional

Permanent RACs: Limited

External validation process

Demonstration RACs: Not required

Permanent RACs: Mandatory

Editor’s note: For more differences in the permanent program, see the next edition of Patient Access Weekly Advisor Nov. 5, 2008.