RAC Expands to Medicaid by Year-End
The Patient Protection and Affordable Care Act (health reform law) enacted earlier this year mandates the expansion of recovery audit contractor (RAC) audits beyond Medicare to Medicaid by the end of this year. While RACs are gung-ho to begin auditing, administrators at the Centers for Medicare & Medicaid Services (CMS) are voicing concerns whether coordinating with 50 state programs is manageable.
In an American Medical Association (AMA) American Medical News article, CMS officials told a Congressional panel expanding the three-year program on time will be a tall order. “We’re still in the planning stages,” Deborah Taylor, director and chief financial officer of CMS Office of Financial Management, said. “We’re looking a little harder at Medicaid [because] it’s going to be tougher for us.”
She told the committee that CMS is farther ahead in implementing RAC audits for the Medicare Part D prescription program for seniors.
Sen. Tom Carper (D-Del.) told Taylor to continue working with her colleagues to meet the deadline. “The program has been successful,” said Carper. “The sooner the full program is up and running, the sooner we can recover millions of dollars—probably billions of dollars—in additional overpayments and put them to more effective use.” The RAC program nabbed $54 million in its first year and $247 million in its second year for the Medicare trust fund, Carper noted.
Auditors, who are paid based on the dollar amount of any improper payments recovered, are anxious to begin. “This may sound self-serving, but we are ready to take on more work,” Lisa Im, CEO of Performant Financial Corp., a former RAC demonstration contractor, told the Congressional panel. “This contract implementation is just the beginning but has great potential to succeed in returning dollars to CMS.”
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