Given the current economic climate and the complicated assessment and billing systems that are utilized in our industry, it is not difficult to see why the RACs will be highly interested in our organizations and facilities.  Are you ready?  As your partner in the long term care industry, we want to make sure you are. 

Just like the Boy Scout motto:  "Be Prepared," documentation is a critical component to stave off a review or to defend a finding of recoupment.  For this reason, we designed CareWatch and UB Watch^™ to work in conjunction with one another as a system of checks and balances between your MDS clinical findings and individual UB-04 claims.  We encourage you to explore how these innovative programs function as an aggregate to help you provide resident-centered care while you manage your revenue with acumen and financial integrity.

The Recovery Audit Contractor program is deep and wide.  While it may seem intimidating to think of the possibility of being audited by the RACs, there are clear guidelines, clear practices, and specific rules that the RACs must follow--and a stringent appeals process if need be. 

As a service to you, we have prepared a detailed white paper which describes the RAC program; it's practices, policies, and protocols; how to prepare and organize before you receive notice of a review; during a review; and how to appeal in the instance that a demand for recoupment of funds is made.  We have also included a flow chart outlining the appeals process and copies of the various CMS appeals forms should you have the need.  To read the white paper in full or to print out a copy for your records, please click here.  For the appeals forms, please click on any of the following links or follow the directions given when first opening the document.

• Medicare Reconsideration Request Form
• Medicare Redetermination Request Form
• Request for Medicare Hearing by an Administrative Law Judge
• Request for Medicare Appeals Council DAB Form