CMS Publishes FAQ on Medicaid Recovery Audit Contractor Program

by Rebecca Farley on January 19, 2012

According to new guidance from the Centers for Medicare and Medicaid Services, Medicaid Recovery Audit Contractors will not replace existing Medicaid program integrity contractors under the terms of a final rule issued in September 2011. The recently released Frequently Asked Questions document also provides a refresher on the Recovery Audit Contractors (RAC) program.

The RAC model was created for Medicare in 2003; it was then expanded to Medicaid under Section 6411(a) of the Affordable Care Act. The ACA requires each state to establish a Medicaid RAC program so as to enable the auditing of claims for services furnished by Medicaid providers. These Medicaid RACs must identify overpayments and underpayments and must coordinate their recovery audit efforts with other contractors or entities performing similar work. The Medicaid RAC requirements became effective January 1, 2012, except for states that were granted an exemption by CMS.

CMS’ new FAQ offers advice on how states can prepare Medicaid providers for upcoming RAC audits. It suggests that states should provide:

  • The name and contact information of the RAC selected by the state;
  • A timeframe for when the RAC will begin identifying overpayments and underpayments; and
  • General information on the RAC program.

The FAQ notes that states may exclude Medicaid managed care claims from review by the Medicaid RACs.


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{ 1 comment… read it below or add one }

West Palm Beach Physical Therapy January 27, 2012 at 1:06 pm

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