Author: Tom Entrikin | Posted: 15. September 2011 08:46

The Centers for Medicare and Medicaid Services (CMS) has released final rules governing the Medicaid Recovery Audit Contractor (RAC) program authorized under section 6411 of the Affordable Care Act (ACA).   The final rules are effective January 1, 2012.  CMS estimates that the Medicaid RAC program will achieve net savings of $2.13 billion (including $910 million in net savings to states) over federal FY 2012-2016.  The rules require states to contract with Medicaid RACs on a contingency fee basis at rates not to exceed 12.5 percent of Medicaid provider overpayment recoveries that are achieved by the RACs.    States are required under the rules to establish procedures to ensure coordination of Medicaid RAC audits with other audit activities, an appeals process for Medicaid providers, and referral of suspected cases of fraud and abuse to state Medicaid fraud control units and law enforcement authorities.   RACs are required to hire qualified personnel as defined in the rule, to offer a toll-free telephone line to help resolve providers’ questions about data requests and audit findings, to accept data from providers electronically, to inform providers about overpayments and underpayments, and to work with states to develop education and outreach programs for providers about the Medicaid RAC program.   The final rules will appear in the Federal Register on Friday, September 16.