The Medicare Recovery Audit Contractor Program

Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment

The Centers for Medicare & Medicaid Services (CMS) conducted a three-year project to demonstrate the use of recovery audit contractors (RAC) in identifying Medicare improper payments and recouping overpayments. This report examined issues that arose during the demonstration project and CMS¿s efforts to address them in the national RAC program. It examines the extent to which CMS: (1) developed a process and took corrective actions to address vulnerabilities identified by the RACs that led to improper payments; (2) resolved coordination issues between the RACs and the Medicare claims admin. contractors; and (3) established methods to oversee RAC claim review accuracy and provider service during the national program. Charts and tables.

RACs are auditing practices. Learn how to prepare. The RAC Toolkit for Physician Practices is your practice's answer to turning plans into proactive action for RAC success. Authors Elizabeth Lamkin, MHA, and Amanda Berglund, MS, MBA, describe how to establish and sustain an effective RAC-preparedness structure that can be adapted to fit any organization's system. They provide best practices for successful processes and outline each staff member's role in your RAC audit program. Physician practice settings are getting audited by RACs. Whether you're dealing with a RAC or another government auditor, you need a program that's running as effectively as it can be. You will use their tested, proven, and practical tools to build a more effective billing compliance program. You'll learn how to bring finance, business office and clinical groups together for operational improvements that drop right to the bottom line. The RAC Toolkit for Physician Practices will help you get the job done right. The RAC Toolkit for Physician Practices will show you how to: * Take a systemic approach to RAC compliance * Incorporate effective structure and processes to existing systems for measurable results * Organize committees and facilitate information flow * Appeal effectively and within deadlines * Use proven tools and methods for an effective RAC program

Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment

Medicaid Program - Recovery Audit Contractors (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) The Law Library presents the complete text of the Medicaid Program - Recovery Audit Contractors (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition). Updated as of May 29, 2018 This final rule implements section 6411 of the Patient Protection and Affordable Care Act (the Affordable Care Act), and provides guidance to States related to Federal/State funding of State start-up, operation and maintenance costs of Medicaid Recovery Audit Contractors (Medicaid RACs) and the payment methodology for State payments to Medicaid RACs. This rule also directs States to assure that adequate appeal processes are in place for providers to dispute adverse determinations made by Medicaid RACs. Lastly, the rule directs States to coordinate with other contractors and entities auditing Medicaid providers and with State and Federal law enforcement agencies. This book contains: - The complete text of the Medicaid Program - Recovery Audit Contractors (US Centers for Medicare and Medicaid Services Regulation) (CMS) (2018 Edition) - A table of contents with the page number of each section

Medicare recovery audit contractors and CMS's actions to address improper payments, referrals of potential fraud, and performance.