To recognize in section 306 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), directed by Congress by the Department of Health and Human Services (DHHS) to a 3-year program with a demonstration Recovery Audit Contractors (RAC) and proper conduct improper payments in the FFS Medicare program.
The Recovery Audit Contractor (RAC) demonstration program was designed to determine whether the use of RACs will be a cost-effective means of addingResources to ensure correct payments to the vendors and suppliers, and therefore to protect the Medicare Trust Fund. The demonstration operated in New York, Massachusetts, Florida, South Carolina and California and 27 Ended in March 2008.
RAC succeeded in correcting more than $ 1.03 billion of Medicare improper payments About 96% were overpayments collected from providers, while the remaining 4 percent were underpayments repaid to providers.
§ 302the Tax Relief and Health Care Act of 2006 makes the RAC program permanent and requires the Secretary, the program to all 50 states through the expansion by 2010.
According to CMS, the RAC demonstration program has proven, in the repatriation of dollars to the Medicare Trust Funds and identifying monies that must be returned to the vendor to be successful. It has provided CMS with a new mechanism for detecting improper payments in the past and has also made available a valuable new tool for CMSPrevention of future payments.
The objective of the audit recovery program is to respond to claims of improper payments for Medicare health-vesting and entitled to services. Improper payments can overpayments or underpayments. Overpayments can occur when healthcare providers submit claims do not meet Medicare coding or medical necessity policy. Underpayments can occur when health care providers to submit claims for a simple procedure, but the medical records indicate thata more complicated procedure was actually performed. Health care providers that may be reviewed, including hospitals, doctors' offices, nursing homes, home health agencies, durable medical equipment suppliers, and any other vendor or supplier that bills Medicare Part A and B.
It is more important than ever that you check your current billing and compliance guidelines to ensure that you are in compliance with the provisions required by the Centers for Medicare & Medicaid Services, thecan you take corrective action immediately if discrepancies are identified.
