Recovery Audit Contractors

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The OIG has called on CMS to strengthen activities to prevent improper Medicare payments, including enhancements to the Recovery Audit Contractor (RAC) program. For instance, the OIG notes that RACs identified half of all claims they reviewed in FYs 2010 and 2011 as having resulted in improper payments totaling $1.3 billion. While CMS took corrective…

A number of recent Congressional hearings have focused on health policy issues, including the following:

  • The House Energy and Commerce Committee held hearings on bipartisan proposals to redesign the Medicare benefit structure and challenges facing businesses under the ACA. A June 28 hearing will focus on Medicare Part B drug program reforms.
  • House Ways and

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CMS has released a report to Congress on “Recovery Auditing in the Medicare and Medicaid Programs for Fiscal Year 2011”.  According to CMS, recovery auditors identified and corrected 887,291 claims amounting to $939.3 million in improper payments in fiscal year 2011; while most of the improper payments ($797.4 million) were overpayments, the auditors also were…

CMS has released its 2011 Ombudsman Report to Congress, which describes the activities of the Office of the Medicare Ombudsman (OMO) and sets forth the OMO’s recommendations for improving beneficiaries’ experiences with Medicare. Specific recommendations to CMS cover three topics: (1) recovery of conditional payments from beneficiaries by the Medicare Secondary Payer Recovery Contractor;…

CMS has announced that its Recovery Audit Prepayment Review Demonstration, originally scheduled to launch on January 1, 2012, is now scheduled to begin on August 27, 2012. Under this program, CMS plans to expand the use of Medicare Recovery Auditors in the Medicare fee-for-service program to review claims before they are paid. The demonstration…

CMS has developed a “Provider Compliance Interactive Map” web page as a reference tool with state-specific contact information for the following types of Medicare contractors: Payment Error Rate Measurement (PERM), Comprehensive Error Rate Testing (CERT), Medicare Recovery Audit Operations (RACs), and Medicare Administrative Contractor (MACs).

CMS has announced that its Recovery Audit Prepayment Review Demonstration, originally scheduled to launch on January 1, 2012, is now scheduled to begin on August 27, 2012. Under this program, CMS plans to expand the use of Medicare Recovery Auditors in the Medicare fee-for-service program to review claims before they are paid.  The demonstration…

On February 24, 2012, CMS published a notice announcing an increase to the maximum contingency fee that may be paid to Medicaid Recovery Audit Contractors (RACs) for which federal financial participation (FFP) will be available. Specifically, CMS now authorize states to pay their respective Medicaid RACs a contingency fee of up to 17.5% of the…

On December 21, 2011, CMS is hosting a special open door forum provider call on its Medicare Fee-For-Service Recovery Auditor Prepayment Review Demonstration, which will expand the use of Medicare Recovery Auditors in the Medicare fee-for-service program to review claims before they are paid. This demonstration will focus on seven states with high populations of…

CMS has posted FY 2011 statistics on the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program, under which CMS contractors are tasked with detecting and correcting past improper Medicare payments. From October 2010 through September 2011, CMS states that RACs have corrected $939.4 million in total payments, the bulk of which ($797.4 million) were recoupments of…

CMS has released a report entitled “Implementation of Recovery Auditing at the Centers for Medicare & Medicaid Services.”  The report discusses the evolution of the Recovery Audit Contractor (RAC) program, describes key program components, and provides detailed FY 2010 results, including collection and underpayment data by claim type and issue.

On September 16, 2011, CMS published a final rule to implement section 6411 of the ACA, which requires all states to contract with Recovery Audit Contractors (RACs) to audit Medicaid claims, identify underpayments and overpayments, and recover overpayments or correct underpayments (similar to the Medicare RAC program). RACs will be paid a contingency fee out …

CMS has released new statistics on the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program, under which CMS contractors are tasked with detecting and correcting past improper Medicare payments. As of the third quarter of FY 2011, RACs have corrected $592.5 million in total payments, including $233.4 million in provider overpayments and $55.9 million in underpayments. …

CMS has released new statistics on the Medicare Fee-for-Service Recovery Audit Contractor (RAC) program, under which CMS contractors are tasked with detecting and correcting past improper Medicare payments. In the first three months of 2011 alone, RACs corrected $184.6 million in total payments, including $162 million in provider overpayments and $22.6 million in underpayments. This…

Under the ACA, states and territories must establish Medicaid Recovery Audit Contractors (RACs) to identify and recover Medicaid overpayments and identify underpayments. CMS had previously called on states to fully implement their RAC programs by April 1, 2011. In light of operational issues and a pending rulemaking implementing the Medicaid RAC program, however, CMS has…

On November 10, 2010, CMS published a proposed rule that would provide guidance to states on funding and operation for the Medicaid RAC program. By way of background, the ACA requires all states to contract with RACs to audit Medicaid claims, identify underpayments and overpayments, and recover overpayments or correct underpayments (similar to the…