The Medicare RAC Program is designed to augment exiting Medicare audit capacity and, in the words of former CMS Administrator Mark McClellan, M.D., Ph.D...
“There are two parts to making certain that Medicare dollars go to their intended purposes,” said CMS Administrator Mark McClellan, M.D., Ph.D. “First, we need clear and straightforward rules to assure that fair payments are made for services to Medicare beneficiaries and second we need effective mechanisms in place to detect and respond to inappropriate billing. In conjunction with new steps to ensure Medicare’s billing rules are clear, this demonstration will let us test a new approach to ensure that payments made to providers are accurate.”
This RAC expansion map shows the states affected on October 11.
My experience in Medicare Part B outpatient physical therapy is that the RAC audits affected PT's in Florida very little..
We had less than $100 in post-pay audits in the four-year scope of the three-year demonstration project.
Overall, Physician Groups had about $19 million seized as part of the RAC demonstration project.
Most of the money came from inpatient hospitals.
Get the full RAC demonstration report here.
