CMS Delays Medicaid RAC Implementation

The Center for Medicare and Medicaid Services has delayed the April 1st deadline for states to implement their Medicaid Recovery Audit Contractor (RAC) programs.  CMS anticipates a new deadline will be included in the final rule to be issued later this year.

The Medicaid RAC program (like Medicare RAC’s) will allow third-party auditors contracted by the state to keep a contingency fee based on the amount of provider payments identified as improper.  Medicaid RAC’s would not replace existing integrity/fraud initiatives, but The Affordable Care Act required states to contract with at least one outside auditor by December 31, 2010 and report the effectiveness of existing programs.

OP Practitioners must remain vigilant in their coding and record keeping moving forward to avoid the harsh scrutiny/penalties of the RAC’s.

Read the full release from CMS here

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