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… Read More >

Senate Report Finds Medicare Audit Programs Have Failed to Reduce Improper Payment Rate

The Senate Special Committee on Aging recently issued a report addressing the current Medicare audit programs, the impact of these programs on reducing improper payment rates and the burden providers face when undergoing a Medicare audit. The report outlines inefficiencies related to the lack of coordination among the audit contractors and the failure to effectively target problem providers or problem areas. The report notes that in fiscal year (FY) 2013, CMS reported an estimated $50 billion in Medicare fee-for-service improper… Read More >

House Lawmakers Call for Immediate Reform to the Recovery Audit Contractor (RAC) Process

A bipartisan group of House members called for immediate reforms to the Medicare RAC program in a February 10, 2014 letter to HHS Secretary Kathleen Sebelius.  The letter cites the structure of the RAC audit and payment system as the key problem:  RACs are permitted to audit medical records and claims three years after the services have been provided and are paid a commission on the dollar amount of the claims they deny.  The payment structure incentivizes RACs to deny claims… Read More >

AHA RACTrac 2013 Third Quarter Results: Increase in RAC Activity

The American Hospital Association (AHA) recently released the third quarter results of its RACTrac survey.  RACTrac is a free, web-based survey aimed at collecting information regarding the impact of CMS’s Recovery Audit Contractor (RAC) program on hospitals nationwide. Results for the third quarter included 1,269 participating hospitals.  Overall, participating hospitals reported a considerable increase in RAC activity, both in terms of medial record request and complex audit denials.  Medical record requests were reportedly up 13 percent since the first quarter… Read More >