RAC Ready?

We are currently going through the process of getting ready for RAC , who will be coming to Georgia next year - 09.  As we are hearing all the horror stories,  is there anything we can do now to prepare.  We are auditing charts, but it looks like the RAC has authority to deny claims with no justification at all.  We are a critical access hospital and if anyone has any experience with RAC in a critical access hospital ,  I would appreciate any advise you have to share.

We have been through a 20 claim review in Florida for 2 practioners. We had a remarkable 80% error rate based on the reviewers findings. We were amazed at the lengths this reviewer went to find fault. For multiple claims they denied payment because the reviewer did not feel the PLOF was up to her standards.

Against the LCD she openly admitted to not reviewing the whole chart stating that "If you did not meet the PLOF requirement I don't need to go any further" It has been one error from First coast after another for 1.5 years. They have done everything in their power to drop the ball.

Most recently, after our initial denials we sent a rebuttal letter as part of the process to start an appeal. The redetermination detpartment considered, in error, that to be our appeal. It was clearly written by our attorney that it was not the appeal but the rebuttal. They denied the appeal. After weeks of phone calls, they agreed that an error was made and the case would be "reopened". The actual appeal was sent with all the documentation including scientific basis for our claims, outcomes and proper utilization of the services. They recieved that package with in the time frame they set with documentation of tracking numbers and signature of receipt from the carrier.  8 months later, which is out of compliane with CMS time frame for First coast to respond by 6 months, we spoke with a representative to inquire when we would finally have an answer for our appeal, "It was filed and never considered." "it was deemed redundant to the original appeal(rebuttal letter). After further turmoil we were told the case was reopened, "we are so sorry this happened"

1 week ago we recieved a letter that the appeal was not favorable because it was recieved late with the date they claim they recieved it as the 8 month phone call. Absolutely amazing.

They have lost patient documentation, delayed our process of appeals, dismissed protocols set by CMS, and there is no one who honestly oversees their(Firstcoast) behavior.

We are actively looking for other individuals in Florida who have had similar results and complaints. We are pursuing the course of Florida legislative intervention. We would like to hear from anyone who would like to attest to the mishandling of reviews, claims, denials, appeals and any other inappropriate errors from First coast service options.

Please email me at physicaltherapy33@gmail.com

We are very eager to have this matter addressed by Florida senators and immediate action is needed.

If I remember correclty, the people performing these audits are paid a commission based on the errors they find. I think that is a problem. Who is there to double check these auditors?