CMS: RAC program will restart this month

CMS has announced the Medicare Recovery Audit Contractor program — used to review Medicare claims and return misused funds to the Medicare Trust Fund — will be reinstated to review limited billing issues beginning this month.

The American Hospital Association has urged CMS to improve the RAC program by adopting the reforms included in the Medicare Audit Improvement Act of 2013, under which Medicare RACs would be limited to a hard cap of additional medical record requests. Rep. Jim McDermott (D-Wash.), a ranking member of the House Ways and Means Health Subcommittee, has also called on CMS to reform the RAC program to enhance auditor accountability and performance.

In addition, the AHA has expressed concern about the temporary suspension in administrative law judge hearings concerning payment denials from RACs. The AHA has urged CMS to work with the Office of Medicare Hearings and Appeals to address the suspension to mitigate detrimental effects for hospitals. Additionally, 111 House members sent a letter to HHS Secretary Kathleen Sebelius asking her to take immediate action to reform the RAC program.

In February, CMS announced it would "pause" additional documentation requests from Medicare RACs, while the agency procured the next round of RAC contracts. The previous RAC contracts ended June 1. CMS said the pause in operations would allow auditor to complete all outstanding claims reviews before their contracts expired and allow CMS to refine the RAC program.

Under the new contract arrangement, RACs will conduct reviews on claims related to spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures.

More articles on the RAC program:

8 Recent Stories on Medicare 
CMS: 5 Key Measures of Success for Medicare RACs
Medicare and Medicaid RACs in FY 2012: 8 Statistics

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