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The Trouble with Medicaid RACs

James Carroll, for HealthLeaders Media, March 27, 2012

Potential problems
One of the main points of contention when it comes to Medicaid RACs is how hospital systems that serve multiple states will be handled. Since Medicaid programs are going to be state-administered, many hospitals may find themselves pulled in different directions when it comes to handling this process.

Organizations that fall into this category should work with their hospital association, state and federal legislators, and the American Hospital Association  to lobby for uniformity across the country, in terms of rules and regulations. In addition, providers can also go directly to an auditor that serves multiple states to attempt to make it standardized, according to Lamkin.

Concerning some of the actual issues that the RACs will be auditing, it's a bit early to offer trends or hot topic areas, but it's likely that some of the same CMS-identified issues for Medicare recovery auditors will be approved for Medicaid RACs.

These include medical necessity claims, durable medical equipment  claims, units-of-therapy claims, as well as other high-dollar issues such as cardiac claims, which are already highly-targeted in the Medicare program, suggests Lamkin.

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