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Medicare Compliance & Reimbursement

Medicaid:

RAC 'Bounty Hunters' Turning Their Sights on Medicaid Claims

Published on Fri Feb 25, 2011

Fortunately, recent delays give you more time to plan for these audits. If you thought you had already gotten your fill of recovery audit contractors (RACs) via your Part B claims, get ready for a whole new wave of audits. Thanks to last year's Patient Protection and Affordable Care Act, it looks like RAC auditors will soon be reviewing Medicaid claims as well. In place for Medicare contractors since 2005, RACs are often referred to as medical "bounty hunters" because they only make money if they collect overpayments from you. Their income is specifically tied to the amount they recover, and is based on a percentage of the overpayments they identify. "Medicaid RACs are tasked with identifying and recovering Medicaid overpayments and identifying underpayments," the CMS Web site notes. The agency sent a letter to each state's Medicaid director informing them of the RAC audit specifications (www.cms.gov/smdl/downloads/SMD10021.pdf). Initially, RACs [...]
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