In February, the Centers for Medicare and Medicaid Services (CMS) began rolling out its national Recovery Audit Contractor (RAC) program, aimed at ferreting out improper payments and preventing fraud, waste and abuse in the Medicare system. If you bill for Medicare fee-for-service, you are fair game for a RAC audit. A three-year demonstration of the RAC program, which ended in March 2008, heavily targeted bronchoscopy, injectable drugs and IV hydration therapy. But auditors are rapidly expanding the list, and the permanent program will include adenoidectomies, tonsillectomies, thyroidectomies and other otolaryngology-related procedures.
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April 2010Program Rationale and Process
CMS has contracted with four regional RACs for the permanent nationwide program; each will use proprietary auditing software to review paid claims from Medicare Part A and B providers to ensure they meet Medicare’s statutory, regulatory and policy requirements and regulations.
The RACs are ramping up their claim review activities in all states, said Connie Leonard, director of CMS’s Division of Recovery Audit Operations. When overpayments are confirmed, the RACs issue letters demanding that you repay your Medicare carrier or intermediary within 30 days. For confirmed underpayments, your carrier or intermediary forwards the additional payment to you, Leonard said.