CHA News Article

Improvements Announced for Medicare Recovery Audit Contractor Program
For CFOs

The Centers for Medicare & Medicaid Services (CMS) this week announced a number of improvements to the Medicare Recovery Audit Contractor (RAC) Program, seeking to reduce providers’ burden by better targeting program integrity efforts. 

CMS announced a number of steps to improve oversight of RACs, including requiring them to maintain a 95 percent accuracy score and an overturn rate of less than 10 percent, and hold payment of contingency fees until after the second level of appeal is exhausted. In addition, CMS intends to reduce burden on providers by requiring RACs to audit proportionately to the types of claims a provider submits, directing RACs to conduct fewer audits for providers with low claims denial rates, and giving providers more time to submit additional documentation before repaying a claim.

Finally, CMS announced steps to improve program transparency by regularly seeking public comment on newly proposed RAC areas for review and requirements to enhance their provider portals to better explain claim status.

As a reminder, California’s RAC is Noridian. Additional information on the Medicare RAC Program can be found at on CMS’ website.

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