A recent article from the American Hospital Association (AHA) discussed the costs associated with appealing a RAC audit.  The AHA paper is quite revealing of how the RACs posses numerous advantages in extracting a refund from you (the only way a RAC get paid for their efforts).    One  of these advantages is that a RAC appeal costs between $2,000 and $7,000 dollars per claim (per individual patient audited).    The cost- benefits ratio of a RAC appeal becomes decidely less attractive for PT appeals because of  the costs.  Why?  If a RAC requests a $1,000 refund, would you be willing to spend between $2,000 to $7,000 to protest this refund?  Probably not.   Do not misinterpret my position.   I understand the arguments based on principle when a person believes thay are being penalized unjustly.   But from a business perspective, the decision to spend between $2,000 - $7,000 to prevent the RAC from capturing $1,000 is a losing proposition.

Regrettably, I must state that the RACs are not auditing records that are free from errors.  Frankly,  RACs do not have to fabricate their findings to obtain a refund.  Medical providers are creating plenty of opportunities for RACS.   When codes are not supported by proper documentation the RACs are emboldened.  There are limits to the RACs'''' authority, but these limits are primarily window dressing.  RACs are limited by the number of charts they can request per 45 day period.  For example a therapy practice with five or less therapist is limited to  auditing 10 charts every 45 days.   However, that 45 day period can be extended indefinitely.  Stated plainly, every 45 days the RAC auditor can request another 10 charts.  Unfortunately, the RACs can go back three years from the date of the audit and continuously request records.  (https://www.cms.gov/RAC/Downloads/PhyADR.pdf).