RACs (Recovery Audit Contractors) have been working as the field portion of the CMS Recovery Audit Program whose purpose is to check and recover Medicare money paid out in error. One of the problems with the RACs functioning as they currently have been is that when the RAC finds an overpayment, they send a letter to the provider demanding the refunds. Once a provider receives the letter they have a limited amount of time to pay up or fight it, if they think the determination is wrong. However, with the RACs the letters are not being mailed out or received by the providers until long after the errors were found and the letters were initially generated, giving providers almost no time for action or reaction when they finally do receive their dated letters.
The new change from CMS takes the burden of mailing the letters away from the RACs and puts it back into Medicare’s hands. Now while the RAC investigates, when they find an error, they will send it to Medicare and Medicare will issue the demand letter with the RAC findings. It is hoped that this will give practices the appropriate amount of time to investigate, pay, or go through the CMS rebuttal process to correct a RAC error against them. Medicare will then follow its usual process for overpayment recovery, timelines, and the appeals process.
The article does make sure to mention that providers shouldn’t hesitate to contact their RAC regarding any audit specific questions. The RACs contact information will be included in the payment demand letters with their findings.
To read the complete AAFP article or have access to their additional information links click here.
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