(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

. Notify providers in writing of potential improper payments within 60 calendar days; letters
to providers must include information regarding the audit review (i.e. audit
name/description), reason for the potential improper payment, and information regarding
the provider’s right to appeal, first through an internal dispute resolution process
conducted by the RAC, and what process should be followed for the dispute resolution
process and/or formal appeal to HHSC.
c. If a provider chooses to dispute the initial improper payment finding through
the RAC’s internal dispute resolution process, RAC will follow-up with letter to the
provider indicating the result of the dispute review, and will include information regarding
the formal appeal process.
d. Establish a system to compile and maintain provider approved addresses and points of
contact, and a mechanism for providers to update changes in address and points of
contact throughout the audit period.
e. Establish a toll-free number and mail address for provider inquiries and customer
support, to be included on all provider correspondence. Toll-free numbers must be
staffed during normal business hours of 8:00 a.m. to 4:30 p.m. Central Time (CT).
Provider support will address items such as provider inquiries regarding medical record
requests, rebuttal deadline extensions, audit process, medical record receipt verification,
audit status, and requests for copies of provider correspondence from the RAC.
f. After consultation with HHSC,, develop an education and outreach program regarding
the recovery audit efforts/processes to providers and stakeholders, as requested.
Examples of education and outreach may include items such as provider notification of
audit policies and procedures, attending provider association and stakeholder meetings,
making presentations on RAC processes and results, answering questions, etc.
2.3.5. Provider Communication and Support – Provider Based Approach
a. At the conclusion of fieldwork on provider based audits, the RAC will adhere to the
following with respect to reporting the results of the audit:
1. Preliminary Draft – RAC submits to HHSC for review;
2. Final Draft – RAC incorporates HHSC preliminary draft comments and forwards
to the audited provider for review and response; and
3. Final Report – RAC considers provider responses, updates revised draft with
approval of HHSC, and issues final report to HHSC and the audited provider.
b. The audit reports will be submitted to HHSC at the conclusion of audit activities for each
audit type conducted. The final audit reports should also include the following:
1. Coversheet with the title “Health and Human Services Commission Provider
Improper Payment Recovery Audit”
2. Date the report is issued
3. RAC’s name and contact information
4. Executive summary in letter format addressed to HHSC summarizing overall
findings
5. Table of contents
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