What do recovery audit contractors do?

What does a Recovery Audit Contractor (RAC) do? RAC’s review claims on a post-payment basis. The RAC’s detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.

What is the look back period for Medicare recovery audit contractors?

In addition, CMS’ Medicare Integrity Program employs Recovery Audit Contractors to identify and correct improper Medicare payments. The RAC program allows for a look-back period of up to five years.

How do I become a recovery audit contractor?

Career Requirements

1. Step 1: Earn an Undergraduate Degree. A bachelor’s degree is usually preferred and often required for aspiring RAC coordinators.
2. Step 2: Obtain a Registered Nurse (RN) License. Many employers require RAC coordinators to be licensed RNs in their state.
3. Step 3: Advance Your Career.

What triggers a RAC audit?

RAC looks for both overpayments made to patients and underpayments made to providers. While many RAC audits do uncover fraud, it is important to note that innocent mistakes or errors in documentation can also trigger an audit. 2. Private contractors will demand correction of the payment.

When did the Medicaid estate recovery program begin in Georgia?

Georgia’s Medicaid Estate Recovery Program, as defined in the Rules of the Department of Community Health, Medical Assistance, Chapter 111-3-8, began May 3, 2006.

Who is the Part D Recovery Audit Contractor?

The Part D Recovery Audit Contractor (RAC) is a contractor that performs data analysis on Prescription Drug Events (PDE) submitted by Part D plan sponsors in order to detect improper payments. The RAC is paid a contingency fee for amounts recovered.

Who are the upics contractors for Medicare and Medicaid?

The Unified Program Integrity Contractors (UPICs) perform fraud, waste, and abuse detection, deterrence and prevention activities for Medicare and Medicaid claims processed in the United States.

Who is the supplemental medical review contractor for Medicare?

SMRC The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. This is a contract that is awarded through competitive procedures in keeping with Section 1874A of the Social Security Act.