RAC coming to Kansas

The Recovery Audit Contractor (RAC), mandated by the Tax Relief and Health Care Act of 2006 directs CMS to implement the RAC program nationwide by January 1, 2010. The goal of the RAC program is to identify improper payment made on claims for services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when claims submitted do not meet Medicare’s coding or medical necessity policies; underpayments can occur when claims for a service are submitted and the medical record revels that a more complicated procedure or service was actually performed.

Kansas is scheduled for RAC phase in August 1, 2009 and may see RAC activities at that time, but no later than January 1, 2010. HealthData Insights Inc., (Las Vegas Nevada) has been awarded the contract for Kansas. RACs will be paid a percentage of money returned to the trust fund; therefore, they are highly motivated to audit.

To prepare for this program it is recommended that you begin conducting an internal assessment to ensure that submitted claims meet Medicare requirements. Additional steps that should be considered:

• Designated a point person to handle all audit and recovery request and appeals

• Perform internal audits or have an outside entity perform one; both KMS and KaMMCO offer audits for a minimal fee.

• Identify any patterns of denied claims and take steps to correct them

• Check the OIG workplan to see what they are targeting

• Stay current with what RACs are targeting

Additional resources

Medicare Report – RAC Demonstration Project
Map of RAC Jurisdictions and RAC Expansion Schedule
Recovery Audit Contractor (RAC) Program Slide Presentation  
Final RAC Statement of Work
Frequently Asked Questions

CR 6183 Limitation on Recoupment
MM 6183 Limitation on Recoupment 
Medicare Appeals Process Brochure 
Appeals Process Diagram
AMA RAC Appeal Document

CMS Handouts from RAC Informational Meetings
HDI Handouts from RAC Informational Meetings