Recovery Audit Contractor Program
Recovery Audit Contractor (RAC) programs target Medicare and Medicaid payments deemed inappropriate by the Centers for Medicare and Medicare Services (CMS) and return under and overpayments to the appropriate government agencies and health care providers.
The Medicare RAC program was created by Congress in 2003 as a demonstration project to determine if independent auditors could be incentivised to help CMS identify and return what CMS considers to be inappropriate payments to health care providers. Expanded to Medicare nationwide in 2006 and to Medicaid in 2010, RACs employ independent auditors that search out alleged 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 both Medicare RAC Region B and for the Ohio Department of Job and Family Services' Medicaid RAC program.
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View information on OHA's TRACKER, a dynamic software tool to help manage RAC records requests, reviews, appeals and recoupments, and which assists hospitals in submitting RAC data to the American Hospital Association for its RACTrac advocacy project. To sign-up for a free Web demonstration, or for more information, contact Amber Yors at ambery@ohanet.org or 614.221.7614.
Medicare RAC Releasing "Blackout" Review Results to MAC
January 11, 2012:
OHA learned this week that CGI Federal, the Ohio Recovery Audit Contractor (RAC) for both Medicare and Medicaid, has slowly started to release backdated Medicare RAC review results, held since last summer because of the Medicare Administrative Contractor (MAC) conversion to CGS. CGI reports it is releasing small batches of backdated review results to CGS in a production mode, which will trigger Demand Letters to providers from CGS, and all appears well. If no glitches are found, CGS will speed up the process and states it should have all "blackout" review results to CGS within a few weeks.
OHA expressed concern that the release of a larger number than normal of review results, in combination with the new MAC responsibility to issue Demand Letters, will cause confusion, especially if, as is expected, the Demand Letters are not addressed to hospitals' usual RAC contacts. CGI responded that hospitals can track the release of review results on its provider portal website and, while it cannot issues copies of Demand Letters itself, the portal should alert hospitals to the release of review results, so they can contact CGS Customer Service, if necessary.
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