CMS Again Delays RAC Prepayment Audits

The Centers for Medicare and Medicaid Services recently announced that it will again delay a program designed to decrease fraud and abuse by verifying claims prior to approval, rather than chasing payment after approval, a program known as the RAC Prepayment Audit Demonstration Project. Originally planned for Jan. 1, then delayed to June 1, prepayment reviews will allow recovery audit contractors (RAC) to review historically improper claims before payment so that providers comply with Medicare rules.
CMS now says the program will move forward at some point in the summer of 2012 and will provide 30 days notice prior to program implementation.
Upon implementation, RAC audits will target seven states with high populations of fraud and error-prone providers: Florida, California, Michigan, Texas, New York, Louisiana, Illinois and four states with high claims volumes of short inpatient hospital stays: Pennsylvania, Ohio, North Carolina, Missouri. The goal is to further prevent the traditional pay-and-chase method, in which Medicare doles out payment and then looks for improper payments after they occur. MORE (O&P Edge)

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