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Recovery Audit Contractors

RACs have been established to reduce improper payments by Medicare, to detect and collect overpayments, and to identify underpayments. They are to implement actions to prevent future improper payments.

There is no phase in strategy, and all Medicare provider types are available for RAC review once they have reached out to the providers. However, Mary’s thought is that they will focus on recovering big dollars from hospitals, Rehab, and major surgeries, since that’s where the biggest opportunities lie. The RACs are paid based on a percentage of the dollars they recover.

There are 4 RACs in place, and each covers one fourth of the country. The RACs jurisdictions match the MAC jurisdictions for DME. Mary suggested that everyone attemd the RAC presentation provided by CMS – Program 814. You need to know where previous improper payment have been found and if you are submitting claims with improper payments. Mary St. Pierre, Vice President for Regulatory Affairs at NAHC suggests that you prepare to respond to RAC Medical Record Requests, and stay calm and stay informed.

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