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What Is Rac In Healthcare?

What Is Rac In Healthcare
What Are Recovery Audit Contractor (RAC) Audits? – Also known as a Medicare audit or a MAC audit, the Recovery Audits Contract (RAC) program is an aggressive campaign seeking reimbursement from healthcare service providers. These audits have become increasingly frequent over the past few years, and they will continue to for the foreseeable future.

What does RAC stand for in healthcare?

Hospitals and health systems focus on caring for patients. Yet, providers face audits of payment claims by third-party entities, including by recovery audit contractors (RACs), that subject hospitals to administrative burden and costly payment denials after care has already been delivered.

  1. The AHA continues to work with government stakeholders to improve the RAC program and prevent abuses that prevent hospitals from receiving payment for necessary medical care.
  2. The AHA also provides education to members to help prevent payment denials and navigate the Medicare appeals process in the event of an adverse RAC payment determination.

RAC-related news, resources and educational materials can be found on this page.

What is the purpose of RAC?

The mission of the Centers for Medicare and Medicaid Services (CMS) Medicare Fee for Service (FFS) Recovery Audit Program is to identify and correct improper payments made on claims for healthcare services provided to Medicare beneficiaries. In January 2010, the Social Security Act authorized the Recovery Audit Program expansion nationwide and extended it to Medicare Parts C and D.

Any medical practice submitting claims to a government program can be subject to a Medicare Recovery Audit Contractor (RAC) audit. RAC audits—which may be triggered by an innocent documentation error—are not one-time or intermittent reviews. They are part of a systematic and concurrent operating process created to ensure compliance with Medicare’s clinical payment criteria and documentation and billing requirements.

The RACs are charged with finding “improper payments”—which could be either an underpayment or an overpayment. The RACs use proprietary software programs to identify potential payment errors in areas such as duplicate payments, fiscal intermediaries’ mistakes, medical necessity, and coding.

RACs also conduct medical record reviews and are required to employ a staff consisting of nurses, therapists, certified coders, and a physician medical director. The appendices of the CMS report Recovery Auditing in Medicare Fee-for-Service for Fiscal Year 2018 identified $89 million in overpayments, recovering $73 million during that fiscal year.

This represents a substantial decrease in payment corrections from prior years. The fiscal year 2015 report identified $359.73 million in overpayments and $80.96 million in underpayments repaid to providers. The RACs detect and correct past improper payments so that CMS can implement actions to prevent future improper payments.

Providers can avoid submitting claims that do not comply with Medicare rules. CMS can lower its payment error rate. Taxpayers and future Medicare beneficiaries are protected.

The following entities are subject to RAC audits:

Hospitals Physician practices. Nursing homes. Home health agencies. Durable medical equipment suppliers. Any provider or supplier that submits claims to Medicare or a government program.

CMS contracted with RAC auditors for five regions in the United States and designated one for each region. It is important to identify the RAC auditor in your region so you can promptly address correspondence from them. CMS has awarded FFS RAC contracts to the following organizations: Region 1: Performant Recovery, Inc.

Region 2: Cotiviti, LLC Region 3: Cotiviti, LLC Region 4: HMS Federal Solutions Region 5: Performant Recovery, Inc. The RAC auditor for Region 5 has a national contract to perform audits of durable medical equipment, prosthetics, orthotics, and supplies claims, as well as home health and hospice claims.

A list of Medicare FFS RAC contact information and regional division of states is available on the CMS website. The RAC, which reviews claims on a post-payment basis paid within the past three years, conducts three types of reviews:

Automated—no medical record needed. Semi-automated—claims review using data and potential human review of a medical record or other documentation. Complex—medical record required.

CMS provides a sortable list of RAC audit issues on its Approved RAC Topics and Proposed RAC Topics pages. These are updated regularly. Assess your risk for coding and billing issues by performing an internal audit of your own practices. Check that all billing codes are supported with appropriate documentation in the medical record.

Consider hiring a contractor or assign a knowledgeable member of your staff to review your coding and billing processes and develop a compliance plan. Identify coding and billing issues, track denied claims, look for patterns, and determine what corrective actions are needed to avoid improper payments. Review for circumstances that can lead to common coding and billing errors, including:

Inadequately trained staff. Lack of time. Not following recommendations in Federal Register Not consulting Health and Human Services bulletins. Misinterpreting rules. New staff/new billing company.

Include these areas in your assessment and monitoring plan:

Review the categories of claims denied in earlier RAC audits. Keep abreast of notifications on the CMS website, including approved and proposed audit topics. Review the Office of Inspector General (OIG) annual Work Plan to identify audit areas. Monitor RAC progress on regional RAC web postings.

What is RAC coding?

What are CMS RACs and how do they affect you? Everyone has heard the fiscal cliff argument from both sides. We have all heard that “entitlement” programs need to be thinned. We have also heard that Medicare is a huge drain on our country, perhaps the most costly of programs implemented.

  1. So what is being done? The Centers for Medicare and Medicaid Services created the Recovery Audit Program.
  2. This is run by the CMS through RACs (Recovery Audit Contractors).
  3. The CMS RACs review claims submitted by healthcare providers looking for errors in the, documentation, and medical necessity to determine if an underpayment was made from Medicare or an over payment was made to the doctor or healthcare facility.

These errors occur at of 36% of all claims filed for doctor visits and out patient procedures where the stay is less than one day. This 36% equates to about 3.5 billion dollars for the FY2012. That is a huge amount of money for taxpayers and providers.

  1. The most common type of error according to CERT is unnecessary medical procedures being billed.
  2. This accounts for 2.6 billion dollars.
  3. The next most costly mistake is insufficient documentation.
  4. This accounts for approximately,5 billion dollars for the FY2012.
  5. The next most costly error occurs in the medical coding, which results in about,6 billion dollars in over payments to providers and about,12 billion in underpayment to providers.

Some of these errors are due to fraud, but most are due to human error. Clearly there is a need for audits. These errors affect us all. For a provider, knowing the process of the auditing program is important so that you can avoid errors thus avoiding underpayment or over payment.

The RACs cannot review claims that are more than three years old. You have the right to appeal a finding, be it an overpayment or a denial All reviews are post-payment audits RACs are bound by National Coverage Determinations (NCDs), Coverage Provisions in Interpretive Manuals, national coverage and coding articles, local coverage determinations (LCDs) and local coverage/coding articles in their jurisdiction. Your regional RAC website posts all claim types that are authorized for audit If manually audited, the RAC is limited to the number of medical files it can request in a 45 day period.

RAC audits affect taxpayers by recovering lost revenue paid out because of these errors made within the Medicare billing system. This is obviously beneficial to our economy. The CMS RAC recovery program affects Medicare recipients by shoring up the entitlement program for future recipients and those just entering the system.

If Medicare goes broke, many elderly will be without medical coverage. In addition, this protects the patient from undergoing unnecessary medical treatments due to fraudulent providers. The RAC Recovery Program is a valuable tool that is cost effective for everyone. To avoid costly errors in your medical and billing coding you can call us at 708.747.4361 to speak with a member of our staff about your needs.

You can also email us at [email protected] : What are CMS RACs and how do they affect you?

What is RAC and how it works?

Understanding RAC status – Reservation Against Cancellation (RAC) is a ticket status in Indian Railway. If your seat is showing RAC status, it means you have a waiting list ticket. Your travel in the respective coach is confirmed by having a Reservation Against Cancellation ticket.

However, it is not confirmed that you will get a full seat or sleeping status by having a Reservation Against Cancellation. If you have a RAC ticket, you can get on the mentioned seat on your train. However, you may not be alone on a RAC seat in a train. The Indian Railway often splits a RAC seat for two passengers.

Since there will be two passengers on a RAC seat, you might not get the sleeping facility at night. Let us understand RAC ticket status with an example. Consider a sleeper coach that has a hundred seats. Suppose that ten seats are reserved for RAC and 90 seats for sleeper class.

  • Let us say you are the 91st person to book a ticket in the sleeper coach and get an RAC.
  • Now, if someone from the first 90 cancels their seat, you will be the first to get a confirmed seat.
  • Your ticket status will be changed from RAC to confirmed.
  • You will get a full sleeper berth in that coach to yourself.

If no one cancels their sleeper seat before the train departure, you will get the allocated RAC seat. You may have to share a sleeper berth with another RAC ticket holder if you do not get a confirmed seat. Besides knowing the RAC full form, you should be aware of the working of a RAC ticket.

What is a RAC request?

● RACs perform automated reviews when. improper payment is obvious. ● In the case of claims that are likely, to contain. errors, the RAC requests medical records from the provider to further review the claims (called a complex review).

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What is the role of a RAC coordinator?

This position provides financial data and analysis for internal and external reporting, ensures the hospital is prepared for RAC audits, responds to audit requests, challenges questionable determinations, and files timely appeals. Coordinates, initiates, monitors, and responds to all audit requests/demands.

What is a RAC review?

Do you have questions or concerns about the Recovery Audit Program? Please e-mail us at [email protected], Please Do Not send Personal Health Information to this e-mail address. The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.

What are the four types of Mac?

A message authentication code (MAC) is a cryptographic checksum on data that uses a session key to detect both accidental and intentional modifications of the data. A MAC requires two inputs: a message and a secret key known only to the originator of the message and its intended recipient(s).

  • This allows the recipient of the message to verify the integrity of the message and authenticate that the messege’s sender has the shared secret key.
  • If a sender doesn’t know the secret key, the hash value would then be different, which would tell the recipient that the message was not from the original sender.

There are four types of MACs: unconditionally secure, hash function-based, stream cipher-based and block cipher-based In the past, the most common approach to creating a MAC was to use block ciphers like Data Encryption Standard (DES), but hash-based MACs (HMACs) which use a secret key in conjunction with a cryptographic hash function to produce a hash, have become more widely used.

Does RAC mean available?

IRCTC RAC (Reservation Against Cancellation), Waitlisted Ticket Booking Rules You Need To Know ​ IRCTC RAC (Reservation Against Cancellation), Waitlisted Ticket Booking Rules You Need To Know What Is Rac In Healthcare In RAC, the passenger is allowed to travel and two passengers share the same berth. IRCTC or Indian Railway Catering and Tourism Corporation, the e-ticketing arm of the Indian Railways, enables the passengers to book train tickets online through its website or mobile app.

If the passenger status is marked as WL followed by a number, it means the passenger has a waitlisted status, according to IRCTC’s website – irctc.co.in. If the passenger status is marked as RAC, it means that the berth is split into two seats for two RAC ticket holders. The status of the tickets might vary based on a variety of reasons. Ticket cancellations by other passengers can increase the chances of confirmation of an RAC or waiting list ticket. RAC/WL ticket holders are also likely to get available seats in different quotas if they remain unused. In RAC (Reservation Against Cancellation), the passenger is allowed to travel and two passengers share the same berth. If a confirmed passenger does not board the train, a full berth is allotted to the passenger with RAC ticket, according to IRCTC. In case of waitlisted ticket, there are two numbers mentioned on the ticket. The numbers detail the position at which a passenger joins the waitlist and the current position in the list. Let’s consider- a ticket with WL5/WL2 means that a passenger joined the WL at position 5, but by the time he/she paid for the ticket and actually bought the ticket online he/she moved to position 2. The position may have varied from WL5 to WL2 either due to a cancellation or due to someone not making a final booking. While the first number (WL5 in this case) will stay the same, the second number will decrease until he/she gets a ticket. A passenger can cancel RAC online ticket up to 30 minutes before the scheduled departure of the train. No refund is permissible after that, said IRCTC. In case of online RAC ticket, if the reservation charts have been prepared, online TDR (Ticket Deposit Receipt) is required to be filed for obtaining refund. Names of the passengers who are left out fully (all the passengers in the transaction) on waiting list after chart preparation, their names are dropped and do not appear in charts. They are not allowed to board the train, according to IRCTC’s website. The cancellation of waiting list passengers are done by IRCTC after chart preparation and refund is credited to customer’s account electronically.

: IRCTC RAC (Reservation Against Cancellation), Waitlisted Ticket Booking Rules You Need To Know

What is the difference between RAC and available?

RAC Ticket – Each train has some specific seats which are meant for RAC listed passengers. The RAC status tickets guarantee the passengers a seat in the train, but not a berth for sleeping. So if you are a passenger with a RAC status, it means that you can enter the train and occupy your seat on the train.

What are the rules for RAC?

RAC New Rules & RAC Seat, Berths Allotment New Rules – RAC Seat and berths Allotment Rules – RAC Ticket Confirmation Rules – How Many RAC Tickets Get Confirmed – How Many RAC Seats Get Confirmed in Sleeper Class – How Many RAC Tickets Get Confirmed in 3ac – RAC New Rules Allotment of RAC berths to passengers – IRCTC New Rules – Allotment of RAC berths to passengers.

No. of additional berths to be provided for RAC passengers : 2 Side Lower berths No. of additional RAC passengers to be provided sitting accommodation : 4 Total No. of berths to be earmarked for RAC passengers : 7 (Side Lower) Total Number of RAC passengers to be provided confirmed accommodation : 14

How Many RAC Tickets Get Confirmed in 3AC Class : 3 AC

No. of additional berths to be provided for RAC passengers : 2 Side Lower Berths No. of additional RAC passengers to be provided sitting accommodation : 4 Total No. of berths to be earmarked for RAC passengers : 4 (Side Lower) Total Number of RAC passengers to be provided confirmed accommodation : 8

How Many RAC Tickets Get Confirmed in 2AC Class : 2 AC

No. of additional berths to be provided for RAC passengers : 1 Side Lower Berths No. of additional RAC passengers to be provided sitting accommodation : 2 Total No. of berths to be earmarked for RAC passengers : 3 (Side Lower) Total Number of RAC passengers to be provided confirmed accommodation : 6

Click Here to Download the Original Order Ministry Of Railway Increases RAC Berths To Allow More Passenger To Travel On Board Trains RAC Seat Allotment Rules Number of RAC Seats in a Train How Many RAC Seats Get Confirmed in Sleeper Class How do I know my RAC is confirmed ? In short RAC means Reservation Against Cancellations, so if you have RAC-1 on your ticket, your ticket will be confirmed which means someone cancels his ticket.

Once the coach number chart of a RAC ticket is prepared and sent to your mobile number or you can check the pnr status from the Indian Railways website. How do I get my RAC confirmed? Seat number is assigned to the CNF level passengers upon completion of the ranking. RAC PNR status passengers can cancel their tickets 30 minutes before departure.

If the rank is in the RAC, the entire berth will be allocated from confirmed passengers who do not board the train. How many RAC tickets get confirmed in sleeper? Sleeper (SL) : Total No. of berths to be earmarked for RAC passengers 7, No. of additional RAC passengers to be provided sitting accommodation 4 in each coach.

  1. Does RAC Means seat confirmed? Yes, if your ticket status is RAC after the illustrated products, your ticket is partially confirmed and you are allowed to board the train.
  2. RAC passengers are allocated half of the side lower berth with another RAC level passenger.
  3. That means a seat is shared between two RAC passengers.

What is CNF in RAC? RAC means reservation against cancellation and confirmation if CNF. In the RAC one must share a berth between two passengers and the CNF belongs to a single berth in a single berth. Can RAC ticket be Cancelled? RAC ticket cancellation charges Cancellation Charges for RAC or Waitlisted Tickets (a) In case of e-tickets shall be cancelled online or online TDR shall be filed within the time limits prescribed under these rules for obtaining refund.

(b) Where a RAC ticket or wait-listed ticket is presented for cancellation, the refund of fare shall be made after deducting the clerkage if the ticket is present for cancellation upto thirty minutes before the scheduled departure of the train irrespective of the distance. Clerkage Charge : Upto 30 minutes before the scheduled departure of the train irrespective of the distance : Clerkage charge Rs.60 per passenger plus GST applicable for all AC Classes (c) No refund shall be granted on RAC ticket or wait-listed ticket after thirty minutes before the scheduled departure of the train.

(d) Where confirmed reservation has been provided to RAC or wait-listed ticket holder at any time upto final preparation of reservation chart, such ticket shall be treated as a reserved ticket and cancellation charges shall be payable in accordance with clause 1 (Cancellation Charges for Confirmed Tickets)

How is RAC calculated?

Refundable accommodation contribution (RAC) – If a resident chooses to pay by lump sum, you will need to calculate the RAC that is equivalent to the DAC amount payable. To do this:

  1. note the maximum permissible interest rate (MPIR) that was current on the day the resident entered care in your service
  2. use this formula: RAC = (DAC amount payable × 365) / MPIR.

You must refund the balance of the RAC when the resident permanently leaves your care.

Can RAC be refunded?

REFUND RULES w.e.f.12 NOVEMBER 2015

Nature of Ticket Time Limit for cancellation of ticket Cancellation Charge per Passenger
(A) Untravelled Unreserved Tickets Within 3 hrs. of the issue of ticket Rs.30/-
(B) Unreserved Tickets issued in advance The ticket is presented upto 24 hrs. of the day preceding the day of journey. Rs.30/-
(C) Untravelled Confirm Reserved Tickets More than 48 hrs. in advance of schedule departure of the train Rs.240/- AC 1 Class Plus GST Rs.200/- AC2,1 st class Plus GST Rs.180/- AC3 tier, CC Plus GST Rs.120/- Sleeper class Rs.60/- Second class.
(D) Untravelled Reserved Tickets Within 48 hrs in advance and upto 12 hrs. before schedule dep, 25% of the fare paid subject to minimum of cancellation charge in clause (C)
(i)Untravelled Reserved Tickets Within 12 hrs in advance and upto 04 hrs. before schedule departure of the train 50% of the fare paid. (subject to the minimum cancellation charges mentioned in condition (C)
No refund after the above prescribed time limit. No refund shall be granted on confirmed ticket after four hours before thescheduled departure of the train.
(ii) Untravelled waitlisted / RAC Tickets Up to 30 minutes before the scheduleddeparture of the train irrespective of the distance. No refund of fare shall be granted on RAC ticket or WL ticket after 30 minutes before the scheduled departure of the train. Rs.60- AC 1 Class Plus GST Rs.60/- AC2,1 st class Plus GST Rs.60/- AC3 tier,CC Plus GST Rs.60/- Sleeper class Rs.60/- Second class –
(E) Partially-used Reserved Tickets for Rajdhani / Shatabdi trains. No refund, since break of journey is not allowed on these trains.
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1)Refund On Tickets Arising Out Of Other Circumstances

Reason for claiming refund Procedure for refund Time limit for claiming refund Amount payable
Failure of AC Produce a printed certificate from the Travelling Ticket Examiner, along with your journey ticket. Within 20 hrs. of the train’s arrival at the destination station. AC 1 Class – Difference between AC 1 Class and First Class fare (Mail/Exp) for the distance AC was not working. AC 2 Tier/3tier sleeper -Difference between these classes and sleeper class fare (Mail/Exp) for the distance AC was not working. AC Chair Car -difference between this and Second class fare (Mail/Exp) for the distance AC was not working.
Travelling in lower class for want of accommodation Produce a printed Certificate from the Travelling Ticket Examiner, along with your journey ticket. Within two days of the date of issue the certificate(excluding the day of issue of the certificare). Difference of fare between the fare paid and fare for the class travelled.
Late running of trains by more than 3 hrs. Surrender your ticket at journey commencing station. The ticket is surrendered upto actual departure of the train. Full fare without any deduction.
Inability of Railways to provide accommodation to reserved passengers Surrender your ticket at journey commencing station. The ticket is surrendered within 03 hours from the actual departure of the train. Full fare without any decuction at journey commencing station. In case of e-ticket, TDR is filed within 03 hours from the actual departure of the train. Full fare without any deduction.
Change in train timings to earlier hours other than as specified in the time-table. Surrender your ticket at the journey commencing station. After the actual departure of the train and within 3 hrs. of the old departure time.(Available for 7 days only from the date of change of train timings, including the day of change). Full fare less clerkage charge of Rs.60/- per passenger.
Missing the connection train for onward journey due to late running of train. Surrender your ticket at the station refund counter. Within 3 hrs. of the actual arrival of the train which has been delayed. Full fare for untravelled portion after retaining fare for the travelled portion.
Cancellation of train due to accidents, breaches or floods Submission of ticket by passenger or relatives. Within 3 days of the scheduled departure of the train. Full fare paid for the entire booked journey.
Death/injury to a passenger in a Railway Accident. Submission of ticket by passenger’s relatives. Within 3 days of the scheduled departure of the train. Full fare paid for the entire booked journey.

2) Cancellation of e- tickets.- (i) The e- ticket may be booked and cancelled through internet and the refund of fare shall be credited to the customer.s account after deducting the charges applicable. (ii) In case of a confirmed e-ticket, refund of fare shall be granted in accordance with rule for unused tickets on which reservation has been made.

  1. In case of RAC e-ticket, refund of fare shall be granted in accordance with rule for unused waitlisted and RAC tickets.
  2. Iii) In case of the waitlisted e-ticket on which status of all the passengers is on waiting list even after preparation of reservation charts, names of all such passengers booked on that Passenger Name Record (PNR) shall be dropped from the reservation chart and refund of fare shall be credited to the customer.s account after deducting the clerkage.

(iv) In case on a party e-ticket or a family e-ticket issued for travel of more than one person, some persons have confirmed reservation and others are on the list of RAC and waiting list, then in case of passengers on RAC or waitlisted not travelling, a certificate has to be obtained from the ticket checking staff to that effect and refund of fare shall be processed online through TDR, indicating the details of the certificate issued by ticket checking staff.

  1. V)The online TDR shall be filed upto seventy two hours of actual arrival of the train at passenger.s destination and the original certificate issued by the ticket checking staff is to be sent through post to Indian Railway Catering and Tourism Corporation (IRCTC).
  2. The fare shall be refunded by Indian Railway Catering and Tourism Corporation (IRCTC) to the customer.s account after due verification.

(vi) In case of e-tickets (confirmed or RAC), if the reservation charts have been prepared, online TDR is required to be filed for obtaining refund. No refund of fare shall be admissible on e- ticket having confirmed reservation in case the request for refund is filed online after four hours beforethe scheduled departure of the train.

No refund of fare shall be admissible on confirmed Tatkal ticket. In case of Tatkal ticket on waitlist, refund of fare shall be granted in accordance with rule for unused waitlisted or RAC tickets.

iii. In case on a party Tatkal ticket or a family Tatkal ticket issued for travel for more than one person, some persons have confirmed reservation and others are on waiting list, full refund of fare, less clerkage, shall be admissible for confirmed passengers also provided that the entire Tatkal ticket is surrendered for cancellation upto thirty minutes before the scheduled departure of the train.

  • 4) Postponement or preponement of journey on a reserved, RAC or waitlisted ticket.
  • The postponement or preponement of journey on confirmed or RAC or waitlisted ticket shall be allowed in the same class and for the same destination instead of any longer distance or any higher class by the same train or by any other train for any subsequent days, subject to condition that the ticket is surrendered during the working hours of reservation office and at least forty eight hours before the scheduled departure of the train in which originally booked.

(5) Non-commencement or missing of journey due to late running of trains.

No cancellation charge or clerkage shall be levied and full fare shall be refunded to all passengers holding reserved, RAC and waitlisted tickets, if the journey is not undertaken due to late running of the train by more than three hours of the scheduled departure of the train from the station commencing the journey subject to condition that the ticket is surrendered upto the actual departure of the train. in case of e-tickets, the TDR is filed online before the actual departure of the train for availing full refund. In case the ticket is cancelled or surrendered or if the request for refund of fare is filed online after the actual departure of the train, no refund of fare shall be admissible.

(6) Lost, misplaced, torn or mutilated tickets: i. No refund of fare in respect of a lost or misplaced ticket shall be granted. ii. Refund of fare shall be granted in respect of a torn or mutilated ticket if its genuineness and authenticity are verifiable on the basis of the particulars visible on the face the ticket.

Iii. If the reservation status of a lost, misplaced, torn or mutilated ticket, at the time of receipt of the application for issuance of a duplicate ticket for the purpose of undertaking journey, is confirmed or RAC and that the duplicate ticket is sought before preparation of reservation chart of the concerned train, the station master shall issue a duplicate ticket in lieu of the original ticket on payment of rupees fifty per passenger in case of second and sleeper class and rupees one hundred per passenger for other classes.

(7) Application for refund of Passenger Reservation System (PRS) tickets in other circumstances:- For refund of fare under circumstances other than those specified in these rules or under circumstances like,bandh. or agitations or floods, etc., the passengers could not reach the reservation counter or station or current counters for cancellation of tickets, in those cases, a TDR shall be issued to the passenger and the passenger may apply for refund of fare within ten days from the day of commencement of journey to the Chief Commercial Manager (Refunds) of the railway administration under whose jurisdiction the TDR issuing station comes, enclosing the original TDR.

The TDR shall be issued only upto three days after the scheduled departure of the train. Guidelines for Passengers for refund of fare.1.Passenger is required to send an application for refund (in the application form as shown below along with original TDR to the Chief Commercial Manager (Refunds)/N.C.Rly., 2 nd Floor, ‘E’ Block, “Chambal Parisar” Subedarganj, Prayagraj.The application must reach the concerned refund office at the earliest but not later than 10 days from the date of journey.2.The certificates, issued by TTE/Conductor for lower class travel AC failure, less number of persons traveling, etc.

are also required to be enclosed in original with the application.3.It will be in the interest of passenger to send the application either by hand or by registered post and keep a copy of this receipt and other documents.4.Refund is granted through Station Pay Order(to be encashed at Station) or Crossed Cheques.

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Station pay Orders are issued to persons who reside only within the jurisdiction of refund granting railway.However, Crossed Chequesis issue to persons who are residing within as well as outside the jurisdiction of refund granting railway.On receipt of Pay Order passenger should approach the counter of nominated station for encashment within the stipulated period along with proof of his/her identity like some identity card/driving licence/passport/ ration card, etc.In case the applicant wants to collect money through his/her representative, appropriate authorization should be made and the authorized persons should like-wise carry proof of identity at the time of encashment.

APPLICATION FOR REFUND OF FARE The Chief Commercial Manager(Refund) NC Railway, E – Block,ChambalParisar, Subedarganj, Prayagraj. Sir, Sub: Claim for refund of fare-Ticket/PNR No. The TDR on prepage was issued on cancellation of the above mentioned ticket(s) at Railway Station.2.Reasons for cancellation of journey: 3.Names of Passengers for whom the ticket was issued: 1.2.3.4.5.6.4.Out of the above persons, the persons at S.

  1. Nos. to,
  2. Did not travel from Station toStatopm.5.Additional information, if any 6.I request that the refund due under the rules, may please be sent to me at my follow address, Name of the Railway Station serving my place of residence is,7.Preferable mode of payment Station Pay Order/Cheque/Money Order.

(Tick mark any one). Signature of Claimant, Name in Block letters Full Postal Address (in clear block letters) PIN Date:,

How is recovery audit done?

From Wikipedia, the free encyclopedia Recovery auditing is the systematic process of reviewing disbursement transactions and the related supporting data to identify and recover various forms of over payments and under-deductions to suppliers. In other words, it is the recovery of lost money.

What causes a RAC audit?

What Does a Recovery Audit Contractor Do? – In 2018, the RAC program identified approximately $89 million in overpayments and recovered $73 million, Since 2009, the program has recouped more than $10 billion for the Medicare program To accomplish these feats, the RAC program employs a variety of different types of audits that seek to identify and recover improper payments across 16 different Medicare programs (e.g., Inpatient Hospital, Outpatient Imaging).

Most of these claims are paid by the federal government to providers in the form of overpayments based on erroneous information provided by facilities or providers for designated services received by beneficiaries. Each audit claim contains two components: 1) A payment component which includes monies owed to providers 2) A recovery component which allows companies conducting the audits to recoup some of the cost of conducting the target audits Any medical provider that submits claims to a government program may be subject to a Medicare Recovery Audit Contractor audit.

RAC audits are not one-time or intermittent reviews and can be triggered by anything from an innocent documentation error to outright fraud. They are part of a systematic and concurrent operating process that ensures compliance with Medicare’s clinical payment criteria, documentation and billing requirements.

What is the purpose of a recovery audit contractor?

The Medicare Prescription Drug Improvement and Modernization Act of 2003, commonly referred to as the Medicare Modernization Act (MMA), included a provision that required the Centers for Medicare & Medicaid Services (CMS) to demonstrate the applicability of audit contractors to identify overpayments and underpayments, and recoup overpayments made by the Medicare program.

  • The following questions and answers are provided to illustrate the CMS initiative of audit contractors.
  • What is an “RAC”? RAC is the abbreviation for “recovery audit contractor.” The purpose of an RAC is to identify overpayments and underpayments made by the Medicare program under Part A and Part B.
  • The RACs are also responsible for the recoupment of overpayments made to providers.

How did the RACs come about? Section 306 of the MMA specifically directed CMS to use audit contractors to investigate Medicare claims. In response to the legislative directive, CMS developed a 3-year demonstration project for the RAC initiative, which began in March 2005.

CMS is required to evaluate the effectiveness of the initiative and provide a report to Congress at the end of the demonstration project. Are there RACs in all states? The CMS RAC demonstration project originally covered California, Florida, and New York. These states were chosen because of their high Medicare utilization numbers.

The contractors covering these three states are as follows: PRG-Schultz for California, Health Data Insights for Florida, Connolly Consulting for New York. Are there plans to expand the RAC initiative to all states? Yes. CMS has plans to expand the program to cover all states.

  1. The initiative has been a very cost-effective program for CMS, and the Tax Relief and Health Care Act of 2006 allows the RAC program to be extended to all states.
  2. The law requires that CMS implement the program in all states by no later than January 1, 2010.CMS plans to have four RACs in total to cover the United States.

Each of the RACs will be responsible for the states in its designated area ( Fig 1 ). Proposed 2008 recovery audit contractor jurisdictions. Who are the audit contractors? The RACs are companies or entities that are separately contracted specifically for this initiative. Existing entities that are currently contracted to process claims for Medicare, carriers, fiscal intermediaries, and Medicare Administrative Contractors are ineligible to bid on RAC contracts due to potential for conflicts of interest.

What claims will the RACs be reviewing? Particular claims or areas of medicine have not been identified by CMS for review. The RACs themselves will analyze claims using their own systems to identify areas they believe require review; however, if a claim has been reviewed by another entity (eg, a carrier, fiscal intermediary, etc), it cannot be reviewed by the RAC.

Can one appeal an RAC determination? Yes. An appeal can be requested. To obtain more information, a provider would contact the individual RAC responsible for the audit. Is the audit performed by the Medicare carrier/fiscal intermediary or by the RAC itself? The RAC is responsible for performing the audit and requesting medical records.

If an overpayment determination is made, the RAC will be responsible for pursuing payment from the provider. If an underpayment is identified, however, the RAC will work with the appropriate carrier/fiscal intermediary to process a payment to the provider. If I have questions about the audit, who should I contact? Providers should contact the RAC responsible for the audit.

The communication you receive regarding the audit should contain the RAC’s contact information. If the RAC cannot be reached or if the provider has questions or concerns, CMS should be contacted. CMS developed a special e-mail ( vog.shh.smc@omedtiduayrevocer ), for questions and concerns regarding the RAC initiative.

What is the role of a recovery audit contractor?

A Recovery Audit Contractor (RAC) is a third-party entity working on behalf of the United States government Centers for Medicare and Medicaid Services to identify and recover improper payments made in Medicare transactions between providers and payors.

These improper payments are identified via audits, commonly referred to as RAC audits. Note that RACs work specifically within Medicare audits. There are third party audit organizations that perform audits for insurance companies, but those are not referred to as RAC or MAC audits. Over the years, the role of RACs has noticeably diminished, or become less of a threat to providers within the healthcare space.

They are also now more commonly referred to as “RAs” rather than RACs. However, they have not vanished entirely. RAC audits and Recovery Audit Contractors will persist for the foreseeable future, and providers should be aware of best practices for response,

Is RAC worth it?

Summary – RAC breakdown cover is often considered more expensive than other car breakdown providers but they do provide a quality service through their expertly trained mechanics. The additional benefits offered, albeit at an extra cost, are well worth researching. If cost is not your primary concern in your search for car breakdown cover then RAC is a strong option.

Why do a recovery audit?

Key Benefits of Recovery Auditing – Benefit #1 – Recovery audits can dramatically improve your bottom line. The most important benefit of recovery audits is that it increases cash flow and pure profits through the identification of revenue leakage. Benefit #2 – Recovery audits can contribute to operational efficiency,

By identifying operational gaps and areas of financial leakage, recovery audits offer a unique opportunity to remedy these issues and make a company’s internal processes more efficient and proactive. Benefit #3 – Recovery audits can potentially identify and address issues with third parties and suppliers.

By acting as a check that ensures accuracy on all parties, recovery audits offer a route for a company to address issues or disconnects with suppliers and ensure contract compliance, This proactive approach to third-party communication prevents issues that could potentially harm the working relationship down the road.

Benefit #4 – Recovery audits can mitigate the risk of fraud. By investigating deep into a business’s financials, the recovery audit process uncovers mistakes, performs a root cause analysis, corrects the error, and prevents the issue from happening again. As a result of this enhanced oversight, recovery audits effectively close the window of opportunity for financial fraud.

Benefit #5 – Prevent future leakage and errors. The ongoing benefit of recovery auditing is that the process finds all the gaps in your financial processes. Identifying internal mistakes such as payment issues, contract noncompliance, or incorrect information, can help businesses correct the mistakes and take action to prevent future mistakes.

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