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CMS Restarts Limited Number of RAC Audits

The Centers for Medicare and Medicaid Services informed congressional health staff members on August 4, 2014, that the Recovery Audit Contractor (RAC) Program is restarting in August.

According to the CMS Communication, “Today, the Centers for Medicare and Medicaid Services announced plans to modify contracts with current Recovery Auditors to allow for a limited number of Medicare fee-for-service claim reviews beginning in August 2014.”

The CMS communication goes on to say, “Current Recovery Auditors will conduct a limited number of automated reviews and a small number of complex reviews on certain claims including, but not limited to: spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies; and cosmetic procedures. The Recovery Auditors will not conduct any inpatient hospital patient status reviews during this limited restart period.”

The goal of the RAC Program is to identify improper payments (i.e. overpayments or underpayments) made on claims for health care services provided to Medicare beneficiaries. This is done on a post-payment review. The claim processing contractors are the entities responsible for adjusting the claim, handling collections (offsets and checks) and reporting the debt on the financial statements.

Because the RAC Program has been restarted on a limited basis, it is a good time to review RAC Audit Procedures. To review what the RAC Program entails and RAC Audit Procedures log in to your account and click on one of your offices, then click on the Reference Guide tab on the left. From here, select the OIG/CMS Fraud Waste and Abuse Reference Guide. Select the section titled Recovery Audit Contractors (RAC) and RAC Audit Procedures.

If you have any additional questions or require further assistance, please do not hesitate to contact one of our professional consultants.

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