Recovery Audit Contractor (RAC) Program
The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program as a demonstration program to identify improper Medicare payments - both overpayments and underpayments. RACs are paid on a contingency fee basis, receiving a percentage of the improper overpayments and underpayments they collect from providers.
The Medicare Modernization Act of 2003 established the Medicare Recovery Audit Contractor (RAC) program as a demonstration program to identifyimporper Medicare payments - both overpayments and underpayments. RACs are paid on a contingency fee basis, receiving a percentage of the improper overpayments and underpayments they collect from providers.
Under the demonstration program, RACs conducted medical record reviews for the last four (4) years of provider claims for the following types of services:
- hospital inpatient
- hospital outpatient
- skilled nursing facility
- physician
- ambulance
- durable medical equipment
- laboratory
The RACs use automated software programs to identify potential payment errors in such areas as
- duplicate payments
- fiscal intermediaries' mistakes
- medical necessity and coding
During fiscal year 2006, the RACs collected $69 million in overpayments and found $3 million in underpayments. An additional $232 million was identified for collections, but the final outcome has yet to be determined.
The Tax Relief and Health Care Act of 2006 made the RAC program permanent and authroized the Centers for Medicare & Medicaid Services (CMS) to expand the program to all 50 states by 2010.
On this site, you will find the latest information on the RAC program expansion and NMHA advocacy efforts and educational activities.
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September 2009 RAC Education Outreach
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RAC Facts
- NMHA's alerts on the RAC Program.
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AHA RAC
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Valerie Barckhoff Presentation 9-16-09
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2010 New Mexico Audit Preparation - The Advisory Board
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RACS & Medicare
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Connolly Medical Record Submission
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Provider Contact Form for Multiple Providers
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Request for Contact Information
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Provider Medical Records Submission Requirements
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RAC Fact Sheet
