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MACs vs. RACs: Could Competition Mean More Bad News for Providers?

Andrea Kraynak, for HealthLeaders Media, September 4, 2009

What's the difference between a MAC and a RAC?

When it comes to protecting Medicare dollars, they share the responsibility of ensuring healthcare providers are paid correctly for services provided, and both conduct audits to help ensure as much.

But once a MAC audits a service, a RAC cannot. And vice versa. So, does that mean there might be a little friendly competition between them?

Deborah K. Hale, CCS, president and CEO of Administrative Consultant Service, LLC, who spoke during the August 13 audio conference, "Inpatient vs. Observation Service: Level of Care Compliance in a Challenging Regulatory Environment," said she's seeing a little bit of competition between MACs and RACs across the country. "We'll have to see how this pans out," she said. "But since those agencies do have the same responsibility, we may see more activity from the MACs than we do from the RACs."

TrailBlazer, a MAC for Hale's home state of Oklahoma, conducted an audit of 250 inpatient discharges for MS-DRG 247 (the DRG for coronary artery drug-eluting stent without a secondary diagnosis that counts as a major complication/comorbidity), according to a TrailBlazer Job Aid.

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