RAC audits will cover Medicaid, Medicare Parts C and D

Thanks to the Patient Protection and Affordable Care Act, the healthcare industry can expect to see a significant expansion of the recovery audit contractor (RAC) program, according to RACmonitor.com. Section 6411 of the Act requires state and federal agencies to institute RAC audits for Medicaid, Medicare Part C (Medicare Advantage plans) and Medicare Part D (prescription drug plans) by Dec. 31, 2010. 

On the Medicaid side, state programs will have to contract with one or more RACs to identify underpayments and overpayments (and recoup overpayments), including in state waiver plans. Medicaid RAC compensation will be linked to the payment inaccuracies they are able to identify. The Medicaid RAC audits will be separate from the Medicaid integrity program (MIP) audits that are already being completed by Medicaid integrity contractors (MICs) in many states.

Currently details are lacking on how RAC audits will be expanded into these new areas. However, additional audits will result in a "heavier administrative burden," says Mary Gabrys, CHC, St. Luke's, Duluth, MN.

To learn more about the RAC expansions:
- read the RACmonitor.com article

To read the specific language of Section 6411:
- access the Act

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