Medicare Recovery Audit Contracting: Weaknesses Remain in Addressing Vulnerabilities to Improper Payments, Although Improvements Made to Contractor Oversight
DIANE Publishing, 2010 - 52 pages
The Centers for Medicare & Medicaid Services (CMS) conducted a three-year project to demonstrate the use of recovery audit contractors (RAC) in identifying Medicare improper payments and recouping overpayments. This report examined issues that arose during the demonstration project and CMS¿s efforts to address them in the national RAC program. It examines the extent to which CMS: (1) developed a process and took corrective actions to address vulnerabilities identified by the RACs that led to improper payments; (2) resolved coordination issues between the RACs and the Medicare claims admin. contractors; and (3) established methods to oversee RAC claim review accuracy and provider service during the national program. Charts and tables.
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3-Year Demonstration According to CMS accuracy of RAC addition address provider concerns address RAC-identified vulnerabilities adequate process agency agency’s appeals process Audit Contractor RAC Centers for Medicare claims adjustment claims administration contractors claims review CMS developed CMS officials told CMS reported CMS’s complex review conduct contingency fees coordination issues corrective action process corrective actions taken data warehouse Department of Health durable medical equipment ensure evaluation report fiscal intermediaries future improper payments implement corrective actions intermediaries and carriers Internal Control IPPP led to improper local coverage determinations Medicaid Services medical necessity medical record request Medicare claims administration Medicare Prescription Drug Medicare Secondary Payer national coverage determination oversight of RAC percent performance metrics prevent future improper provider associations RAC accuracy RAC demonstration project RAC determinations RAC national program RAC review RAC’s Recovery Audit Contractor reduce improper payments responsible Secondary Payer RACs service to providers systems edits underpayments vulnerabilities that led