CMS Restarts the RAC Program


Aug. 4, 2014

CMS Restarts the RAC Program

Medicare’s most effective integrity initiative to resume auditing in August 2014 

Washington, D.C. – The Centers for Medicare and Medicaid Services (CMS) today announced it will allow the Recovery Audit Contractor (RAC) program – used to review Medicare claims, identify billing errors and return misused funds to the Medicare Trust Fund – to review a limited number of billing issues beginning this month.

The previous RAC contracts ended June. 1, halting all Medicare oversight by the program. However, the integrity contractors were still permitted to access and adjust claims in the Medicare appeals process. Under the new contract arrangement, RACs will conduct automated and complex reviews on claims related to spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures.

“Today is a good day for taxpayers and seniors,” said Becky Reeves, spokesperson for the American Coalition for Healthcare Claims Integrity (ACHCI). “This development signals a renewed focus on protecting Medicare’s finite resources, strengthening the Medicare Trust Fund and ensuring seniors’ long-term access to care.”

Mandated by Congress to combat widespread waste in Medicare, the RAC program has returned over $8 billion to the Medicare Trust Fund since in 2009, while reviewing less than 2% of Medicare claims from any given provider. In this time, the initiative has become essential to managing Medicare’s fiscal health.

In March, Congress suspended auditing of short inpatient stay claims – which account the majority of RAC recoveries – from October 2013 to March 2015. According to recent Congressional testimony from Dr. Ellen Evans, Medical Director for a technology company specializing in Medicare integrity, the government will lose $5 billion as a result of this halt to program oversight.

“Medicare loses over $50 billion a year to waste, fraud and abuse, justifying the need for consistent, robust oversight” said Reeves. “Regardless of shifts in policy or procedure, our coalition will continue to focus on bolstering the Medicare Trust Fund, and enhancing program integrity on behalf of seniors and taxpayers.”

For more information, please visit: www.properpayments.com


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