Question

When Recovery Audit Contractors (RAC) identify improper payments as over payments, the

a) Payer is responsible for corrections
b) Provider faces legal penalties
c) Patient receives a refund
d) Claim is automatically denied

Answer 1

When Recovery Audit Contractors (RAC) identify improper payments as over payments, the payer is responsible for corrections. The provider does not face legal penalties, and the patient does not receive a refund.

a) Payer is responsible for corrections

Step-by-step explanation:

When Recovery Audit Contractors (RAC) identify improper payments as over payments, the Payer is responsible for corrections. They have to take the necessary steps to rectify the error and ensure that the overpayment is recovered.

In this situation, the Provider does not face legal penalties as they did not intentionally commit fraud or error. However, they are required to cooperate with the payer during the audit process.

The Patient does not receive a refund in this scenario as the overpayment was made to the provider and not directly to the patient.