The Trouble with Medicaid RACs

James Carroll, March 27, 2012

This is the second in a series covering various topics in the world of recovery auditors. Part two will focus on Medicaid RACs. Part one is here.

Since Medicaid recovery audit contracts officially launched on the first day of 2012, there hasn't been much news surrounding the program. That said, the actual "rollout" of audits and documentation requests are still to come, so providers should start familiarizing themselves with Medicaid's version of the Recovery Auditor Program.

State-by-state differences
While many of the administrative and organizational efficiencies that providers currently use to protect against other government auditors will help, there are a number of marked differences between the two programs. First and foremost is that each state will be set up differently. "This is going to be interesting to say the least, so providers will need to pay particular attention to any guidance released on this program," says Elizabeth Lamkin, CEO, Pace Healthcare Consulting in Hilton Head, SC.

"Providers will need to be especially proactive when it comes to the Medicaid RAC process because the statement of work is so much more vague than the Medicare [Recovery Auditor Program] statement of work," she says. "Though it says that it's modeled after the Medicare statement of work; every state really has the freedom to customize its own program, including the appeals process, different timelines, and the amount of issues they will look at, and so on."

"One hard and fast rule is that RACs have to notify providers of overpayment findings within 60 calendar days. But when it comes to the provider's timeline for returning documentation, each state is going to be different. Providers will definitely need to utilize RAC educational resources for their state's Medicaid."

James Carroll James Carroll is associate editor for the HCPro Revenue Cycle Institute.
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