The Recovery Audit Contractor (RAC) program is going to get much bigger, according to a CMS proposed rule. RAC auditors in your state will start scrutinizing Medicaid claims by 2011.
The health care reform law, the Affordable Care Act, mandates that states have Medicaid RAC contractors operating by Dec. 31. The Medicaid RACs will operate just like Medicare RACs. They will be paid to review provider claims, identify overpayments and recover money. The RACs can also look for underpayments, but that is left to the state's discretion.
"Reducing improper payments is a key goal of the [Obama administration], and the tools provided by the Affordable Care Act will help us achieve that goal," said CMS Administrator Donald Berwick, MD, in a statement about the proposed rule. "We are using many of the lessons that we learned from the Medicare RAC program in the development and implementation of the Medicaid RACs, including a far-reaching education effort for health care providers and state managers."
The law allows CMS to provide extensions or exceptions to states. So, CMS may grant a state additional time to implement a Medicaid RAC program.
You have 60 days to comment on the proposed rule (pdf). You may submit comments on the regulation by going to www.regulations.gov and searching for the rule, CMS-6034-P.