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The RAC Shadow Audit process is restricted to those cases in which the RAC Auditor report claims Medicare payback is warranted. The specific process and scope of work associated with the RAC Shadow Audits is the same as that employed in our RAC Mock Audit program except the cases selected for audit are cases that have already been audited by a RAC contractor.
Benefits
OptumInsight experts audit each case selected by the client and present our findings. When the RAC Audit and OptumInsight audit findings agree, the client can feel more confident that an appeal is not viable and that an opportunity for process improvement is supported by two independent audits.
If the OptumInsight Shadow Audit reaches a conclusion that differs from the RAC contractors, we will present the client with a valuable, third-party evaluation to help support the appeals process. The finding report will compare the RAC audit findings directly with the OptumInsight RAC Shadow Audit Findings and provide supporting documentation for any variances in conclusion between the two audits.
