AHA Coding Clinic® for HCPCS - 2010 Quarter 4; FOR your INFORMATION
Medicaid RACs Coming
The Centers for Medicare & Medicaid Services (CMS) on November 5 released proposed regulations for the new Medicaid Recovery Audit Contractor (RAC) program. The Patient Protection and Affordable Care Act of 2010 (ACA) requires—by December 31—each state Medicaid program to contract with one or more RACs to identify underpayments and overpayments to providers and to recoup overpayments from providers. The proposed rule codifies requirements included in preliminary guidance to states last month, while maintaining significant flexibility in the design and implementation of their programs. The requirements relate to coordination with other government auditors, RAC contingency fees and...
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Article Overview
This article covers proposed Centers for Medicare & Medicaid Services regulations implementing the Medicaid Recovery Audit Contractor program under the Affordable Care Act. It is relevant to Medicaid compliance, provider billing oversight, and audit preparedness, and it discusses the general areas addressed in the proposal, including state implementation timing, coordination with other auditors, contingency fees, and provider due process.
Why This Topic Matters
The article helps readers understand an important Medicaid program integrity initiative and the federal rulemaking affecting how states will set up and operate RAC activities. It is useful for compliance teams, billing staff, auditors, and administrators tracking Medicaid audit policy changes.
What You Will Learn
- What the Medicaid Recovery Audit Contractor program is about at a high level
- Which federal agencies and laws are involved in the proposed rule
- What broad implementation and administrative issues the proposal addresses
- Why the timing of state Medicaid RAC program rollout matters
Who Should Read This
- Medicaid compliance professionals
- Hospital and provider billing staff
- Health care administrators
- Medical auditors
- Revenue cycle teams
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