Castle Rock Medical Group
Medicare RAC Audits & RAC Appeals - Continuing Education
Outstanding RAC References - Proven RAC Results - Unparalleled RAC Appeals Expertise


RAC Audits & RAC Appeals - Regulations / Legislation

Castle Rock Medical Group (a Jackson Davis HealthCare company) has committed thousands of hours to evaluating CMS evidence-based outcomes and clinical payment criteria, Medicare RAC audit focus areas and the effective & efficient submission of Medicare RAC appeals.  In addition, the Castle Rock Medical Group staff has complied the nation's most comprehensive data warehouse of RAC audits & RAC appeals documentation resources - the 2010 RAC Audits & Appeals Guide.

The 2010 RAC Audits & Appeals Guide includes over 5,300 document sources and 125,000 pages of CMS, FI, QIO, CERT and HPMP guidelines and directives that directly address the RAC audit focus areas and provide a foundation for Medicare RAC audit appeals.  The 2010 Guide is available for purchase by healthcare providers and health law firms for $495.00.

Medicare RAC audits pose one of the largest financial and operational challenges to healthcare providers since the initiation of DRGs almost 30 years ago.  Providers around the nation are working hard and committing substantial resources to completing developing and maintaining CMS payment criteria, completing internal audits and establishing a framework to track RAC auditor requests and subsequent RAC appeals.

Regulatory & Legislative Resources

The following is a "first tier" set of RAC regulatory and legislative resources and it is designed to provide a solid starting point for all providers tackling this important issue.

To speak directly with one of our experienced Medicare consultants, clinical auditors or Medicare lawyers - or for questions regarding Medicare RAC audits consulting, RAC appeals or other Medicare fraud & compliance related services - please contact us directly at (303) 586-5003 or compliance@racaudits.com.

Coding/DRG/Health Information Management

RAC Audits - Quality Improvement Organizations (QIO) HPMP Resources

CMS released it's 9th Statement of Work (SOW) for Quality Improvement Organizations (QIOs) and has transitioned the enforcement of inpatient hospital claim policies to RACs nationwide.  As of July 31, 2008 QIOs across the country closed down their HPMP programs and removed detailed supporting documentation from publicly available websites.

One of the nation's most advanced and interactive QIOs, the Texas Medical Foundation, cleared HPMP resources & references from it's website and dozens of policy clarifying documents and educational materials are no longer available for evaluation by providers.

Prior to July 31, 2008, CRMG's Medicare consultants, clinical auditors, billing and compliance professionals compiled over 500 HPMP supporting documents from QIOs nationwide and CRMG has made these vital documents available within the 2009 RAC Audits & Appeals Guide.  These documents are core to providers responding to CMS payment criteria, medical necessity challenges and they are the backbone of insuring compliance with each of the RACs primary focus areas.