Medicaid recovery audit contractors are coming. Each state will choose Medicaid RAC contractors by the end of the year, and contractors will begin operations as early as April 1. Paul Spencer, a consultant at Fi-Med Management in Wauwautosa, Wis., says Medicaid RACs could differ from Medicare RACs in four ways.
1. Appeals process. While Medicare RACs all have one appeals process, each state can have a different appeals process for Medicaid RACs. Rules for Medicaid RACs, however, are expected to be quite similar to those for Medicare RACs.
2. Additional auditing. CMS orchestrates Medicare auditing so that RAC activities do not conflict with other agencies, but it is not clear how Medicaid RACs will coordinate with existing state and federal activities.
3. Medicaid varies by state. Each state has different Medicaid programs and different laws governing them, which could make things difficult for providers and billing companies operating in two or more states.
4. Multiple contractors. While there are only four Medicare RAC contractors nationwide, each state can contract with one or more contractors. This could make it difficult to follow trends by surveying what other RACs are doing.
Find out more about Fi-Med Management.
Read more on RACs:
- CMS to Expand RAC-Style Audits, Double Projected Recoveries
- OIG: RAC Program Lacks Sufficient Fraud Training
- 10 Best Practices for Hospitals to Prepare for, Respond to Recovery Audit Contractors
1. Appeals process. While Medicare RACs all have one appeals process, each state can have a different appeals process for Medicaid RACs. Rules for Medicaid RACs, however, are expected to be quite similar to those for Medicare RACs.
2. Additional auditing. CMS orchestrates Medicare auditing so that RAC activities do not conflict with other agencies, but it is not clear how Medicaid RACs will coordinate with existing state and federal activities.
3. Medicaid varies by state. Each state has different Medicaid programs and different laws governing them, which could make things difficult for providers and billing companies operating in two or more states.
4. Multiple contractors. While there are only four Medicare RAC contractors nationwide, each state can contract with one or more contractors. This could make it difficult to follow trends by surveying what other RACs are doing.
Find out more about Fi-Med Management.
Read more on RACs:
- CMS to Expand RAC-Style Audits, Double Projected Recoveries
- OIG: RAC Program Lacks Sufficient Fraud Training
- 10 Best Practices for Hospitals to Prepare for, Respond to Recovery Audit Contractors