Mr. Spencer said some of the proposed changes do not appear to be realistic, such as exempting states that already have a Medicaid Integrity Program or other audit entity already in place.
But other proposed changes have a greater likelihood of being adopted and tend to mirror rules in the Medicare RAC program, Mr. Spencer wrote. He culled the following proposed changes from comment letters from the AHA and the Kansas, New Jersey, Maryland hospital associations.
1. If the Medicaid RAC determines a claim isn’t medically necessary at a higher billing level, the hospital should be permitted to rebill for an applicable lower payment amount.
2. There should be a RAC data warehouse for Medicaid claims identifying which claims are being reviewed and by what entity.
3. The number of RAC medical record requests should be limited, as in the Medicare RAC program.
4. There should be 12-month look-back period instead of the three-year limit currently in effect on Medicare claims.
5. Medicaid RAC websites should list approved issues and contact information.
6. Trained professionals should review all claims under the guidance of a medical director.
7. Medicaid RAC contingency fees for identifying underpayments should be raised when the ratio of overpayments to underpayments becomes unbalanced.
Read the Fi-Med Blog on RACs.
Read more coverage of RACs:
– Hospitals Asked to Complete RACTrac survey
– 18 Findings from the Latest AHA Survey on RAC Activity
