Recently, the Centers for Medicare and Medicaid Services (CMS) announced the expansion of the Recovery Audit Contractor (RAC) from a three-state pilot (California, New York, and Florida) to a nationwide program by 2010.  The RAC is a Medicare auditing program that contracts private firms to examine physician, hospital, and other medical claims to find instances of overpayment and underpayment.  According to a recent status report by CMS, existing RACs have recovered $303.5 million in improper payments since the spring of 2005. CMS has recouped $68.6 million in overpayments from providers, including physicians, hospitals, nursing homes, and labs for alleged unnecessary services, improper coding and secondary payer issues.

Under the RAC program, auditors are not paid a fee.  They collect 20–30 percent of the money seized from physicians for overcharges.  The expansion into Kentucky is planned for January 2009 or later.

More information on the RAC Program

Certified Coders: The Cost and Benefits

How to perform a physician practice internal billing audit
All members can visit this link - click on “claims processing” to download this brochure.

How to prepare for health insurer retrospective audits
AMA members can visit this link -click on “claims processing” to download this brochure.

 

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