HHS Releases Final Rule for Medicaid RAC Program

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The Department of Health and Human Services released its final rule for the Medicaid Recovery Audit Contractor program, which is expected to save taxpayers $2.1 billion over the next five years, of which $900 million will go back to states, according to an HHS news release.

The new Medicaid RAC program, part of the Patient Protection and Affordable Care Act, is based off the Medicare RAC program, which has recovered nearly $670 million in overpayments so far in 2011.

Provisions of the Medicaid RAC program's final regulations include the following:

•    States may exclude Medicaid managed care claims from review by Medicaid RACs.
•    States must coordinate the recovery audit efforts of their Medicaid RACs with other auditing entities.
•    States must set limits on the number and frequency of medical records to be reviewed by the Medicaid RACs subject to requests for exceptions made by the RACs.
•    Medicaid RACs cannot review claims that are older than three years from the date of the claim, unless it receives approval from the state.

Today's announcement regarding the Medicaid RACs also comes as Vice President Joe Biden summoned a cabinet meeting to discuss waste reduction at federal agencies.

Related Articles on RACs:

CMS Updates RAC Program's Scope
How to Navigate the RAC Appeals Process
Semi-Automated Reviews: How Automation Can Turn a Challenge Into an Opportunity

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