Final Rules for Medicaid RACs Published by CMS
The Patient Protection and Affordable Care Act directs states to enter into contracts with one or more recovery audit contractors (RAC) to identify overpayments and underpayments in the Medicaid program and recoup overpayments. The Medicare RAC program has been in place since 2005 and expanded nationwide effective January 1, 2010.
In October the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director letter that provided preliminary guidance to states on the Medicaid RAC program, including guidance that states needed to attest that they would establish a Medicaid RAC program.
The California Medical Association and the American Medical Association submitted extensive comments to CMS on the proposed rule in an effort to prevent further burdens on doctors who treat Medi-Cal patients. Many of these comments were incorporated into the final rule, including:
- Requiring RACs to hire a 1.0 FTE medical director who is an M.D. or D.O.
- Requiring RACs to hire certified coders
- Requiring RACs to develop an education and outreach program for providers, limiting the look back period to three years
- Requiring RACs to return a contingency fee if an overpayment determination is reversed at any level of appeal
- Requiring states to coordinate RAC audits with other auditing entities
- Prohibiting RACs from auditing claims that have been or are currently being audited by another entity
States must implement the RAC program by January 1, 2012.
For more information, click here.
Contact: David Ford, (916) 551-2554 or dford@cmanet.org.
