Recovery Audit Contractor Program
The Medicare Recovery Audit Contractor (RAC) program exists to identify Medicare payments deemed inappropriate by the Centers for Medicare and Medicare Services (CMS) and to return under and overpayments to providers and the Medicare Trust Fund.
The RAC program was created by Congress in 2003 as a demonstration project to determine if independent auditors could be incented to assist CMS identify and return what CMS considers to be inappropriate payments to health care providers. Expanded nationwide in 2006, the RAC employs four regional independent auditors that search out alleged Medicare under and overpayments using a variety of paid-claims data and medical records reviews, in return for a percent of the dollars identified. CGI Federal, is the contractor for CMS RAC Region B, which includes Ohio.
View January 2010 and March 2010 Issues of the AHA RAC Update
View Archive Issues of OHA Finance News
View information on OHA's RACTracker Software, a dynamic software tool to help track RAC ADRs, reviews, appeals and recoupments, and which automatically submits RAC data to the American Hospital Association. To sign-up for a free Web demonstration or for more information, contact Dorothy Aldridge at dorothya@ohanet.org or 614.221.7614.
RAC Cycle Three Starting; Records Limits Increased
June 15, 2010:
CGI Federal, the Region B Recovery Audit Contractor (RAC) started rolling out the third, 45-day cycle of Additional Documentation Requests (ADRs) this month, increasing the pressure on providers by announcing higher limits on the number of requests it can make each cycle for most Medicare hospitals. The Centers for Medicare & Medicaid Services (CMS) authorized RACs to request up to 300 medical records each 45-day period if an instutional provider had more than 100,000 claims in 2009, although CGI states it is still not requesting as many records as CMS allows. A brief CMS presentation on the revised limits is available. CGI states there will be additional information on its Web site later this month that will lay out how it calculates each hospital's records limits.
For other Ohio RAC developments, including a report on problems with the link between the RAC activities and the Medicare Remittance Advice, go to the April OHA Finance News. CMS also posted a PowerPoint presentation on its RAC adjustment "Section 935" Limitation on Recoupment process.
Other Announcements