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I. INTRODUCTION
Get ready as increased Medicare auditing activity,[link widoczny dla zalogowanych]! The Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nationwide, starting this year. Radiology providers ought act now to assure they have adopted and implemented appropriate compliance programs. Radiology providers should make efforts to understand the Medicare pleas process and should kas long asmany strategies exist that can be successfully employed in the appeals process to defend Medicare audits.
II. RECOVERY AUDIT CONTRACTORS
Section 306 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), directed the Department of Health and Human Services (HHS) to conduct a three-year demonstration program using RACs. The demonstration began in 2005 in the 3 states with the highest Medicare expenditures: California, Florida and New York. The RACs were tasked to identify and correct Medicare overpayments and underpayments,[link widoczny dla zalogowanych], and were recompensed aboard a contingency fare root. The intention of the demonstration program was to make sure if the use of RACs would be a cost-effective course to identify and correct improper Medicare payments.
The RAC demonstration program testified highly “cost effective” from the point of outlook of CMS. Over the course of the three-year demonstration, the RACs identified and collected $992.7 million in overpayments and repaid $37.8 million in underpayments to Medicare providers and suppliers. Based upon message compiled by CMS, the RAC demonstration program cost only 20 pence for every dollar returned to the Medicare Trust Funds.
Section 302 of the Tax Relief and Health Care Act of 2006 makes the RAC program permanent and requires the expansion of the RAC program nationwide by not later than 2010. CMS is actively shaking along with this expansion right now. During the final months of the demonstration program, RACs expanded into South Carolina, Massachusetts, and Arizona. CMS maneuvers to amplify to 19 states at summer 2008, four more states by fall 2008,[link widoczny dla zalogowanych], and the remaining states by January 2009 alternatively later. CMS plans to declare the labels of the “permanent RAC” vendors former behind July 31,[link widoczny dla zalogowanych], 2008. Radiology providers in the 1st 19 states tin expect the commencement of RAC inspecting activity soon after the bulletin of the “permanent RAC” vendors.
Although RACs are responsible for correcting underpayments as well for overpayments,[link widoczny dla zalogowanych], it is the process of recouping testified overpayments that is of particular significance to Medicare providers. Over the course of the three-year demonstration, the RACs identified and collected $992.7 million in overpayments and repaid fair $37.8 million in underpayments to Medicare providers and suppliers. Thus, approximately 96 percent of the alleged improper payments identified were overpayments, as opposed to underpayments. The RACs are permitted to offer to identify unfit payments resulting from anybody of the following:
 Incorrect payments;
 Non-covered services (including services that are no reasonable and essential);
 Incorrectly coded services (including DRG miscoding); and
 Duplicate services.
During the way of the demonstration project, Medicare providers and suppliers heaved cares with certain aspects of the RAC agenda. CMS has made efforts to address these concerns and has adopted many alterations to be implemented in the lasting program. Some of these changes include the following:
 Under the RAC demonstration program,[link widoczny dla zalogowanych], RACs were permitted to reopen claims up to four years emulating the date of initial payment. Amid controversies namely this four year look-back time violated the “provider without fault” provisions of the Social Security Act, under the permanent RAC program, RAC reviewers have a highest three-year look-back time. In always states (regardl