Medicare Recovery Audit Contractors (RACs) Slated to Make a Limited Return

The Centers for Medicare & Medicaid Services (CMS) are set to restart RAC audits for a limited number of fee-for-service claims. Modern Healthcare reported that Lauren Aronson, Director of CMS’ Office of Legislation, sent an email to congressional staffers on August 4 announcing that the Medicare RAC program would restart on a limited basis. CMS is extending the current contracts with the Medicare RAC contractors in this limited restart of the program. Contracts with the current RACs expired on June 1, 2014, which was the last day for RAC contractors to send improper payment files to Medicare Administrative Contractors (MACs) for processing.

It was reported that the RACs will conduct a limited number of automated reviews as well as a limited number of complex reviews on certain claim types, including spinal fusions, outpatient therapy services, durable medical equipment (DME), prosthetics, orthotics and supplies, and cosmetic procedures. These limited RAC audits will not include review of inpatient hospital patient status claims.

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