Recovery Audit Contractor Program
The Centers for Medicare and Medicaid Services (CMS) awarded contracts to four independent agencies, known as Recovery Audit Contractors (RACs), to execute a program identifying improper payments, waste, fraud and abuse within the Medicare and Medicaid programs.
The 2003 Medicare Modernization Act (MMA) §306 required a three-year demonstration project to determine potential efficacy. The Tax Relief and Healthcare Act (TRHCA) of 2006, §302, mandated a nationwide program by 2010. The Patient Protection and Affordable Care Act (PPACA) expanded the program to include Medicaid and, eventually, Medicare Parts C and D. The MMA and TRHCA allow CMS to pay the RACs on a contingency fee basis. The contingency fee must be returned if the RAC loses at any level of appeal.
This FAQ addresses the following:
- What is the Recovery Audit contractor (RAC) program?
- Has the program been successful?
- How do we know what issues are under scrutiny by the RACs?
- Who is my RAC?
- What kind of reviews do the RACs perform?
- How far back can the RAC look at claims for these reviews?
- Are there limits to how many medical records may be requested by the RAC?
- What are the targets for RAC reviews?
- What are the time limits for responding to a RAC request?
- What options exist once we receive the results of the RAC review?
- When an overpayment has been identified, who issues the demand letter?
- How can we prepare for a possible RAC audit?
Purchase This Resource:
Could not load product information
Purchase the FAQ Library:
For best results, please view in Mozilla Firefox.