In Section 306 of the Medicare Medicines Improvement and Modernization Medicines Act 2003 (MMA), Congress directed the Department of Health and Human Services (DHHS) to conduct a 3-year demonstration program using Recovery Audit Contractors (RAC) to detect and correct improper payments in the Medicare FFS program.
The Contractor’s Demonstration Recovery Program (RAC) was designed to determine whether using RAC would be a cost-effective means of adding resources to ensure correct payments to suppliers and suppliers and, therefore, protecting the Medicare Trust Fund. The demonstration operated in New York, Massachusetts, Florida, South Carolina and California and ended on March 27, 2008.
RAC managed to fix more than $ 1.03 billion. US Inadequate Medicare Payments. Almost 96% of them were overpaid, received from suppliers, while the remaining 4 percent received underpayment to suppliers.
Section 302 of the Tax Assistance and Healthcare Act 2006 makes the RAC program permanent and requires the Registrar to extend the program for all 50 states no later than 2010.
According to the CMS, the RAC demonstration program has been successful in returning dollars to Medicare Trust Funds and determining the funds to be returned to suppliers. He provided CMS with a new mechanism for identifying improper payments made in the past, and also provided CMS with a valuable new tool to prevent future payments.
The goal of the recovery audit program is to identify inadequate payments for medical claims made by Medicare beneficiaries. Incorrect payments can be overpay or underpayment. Overpayments can occur when health care providers file applications that do not comply with Medicare or medical need rules. Disadvantages can occur when health care providers apply for a simple procedure, but the medical record shows that a more complex procedure was performed. Health care providers that may be revised include hospitals, physicians, nursing homes, home health care providers, durable medical equipment suppliers, and any other provider or supplier who pays for Medicare Parts A and B.
Currently more critical than ever, you are reviewing your current billing and compliance policy to make sure that you agree with the rules that the Centers for Medicare and Medicaid Services require so that you can take corrective action immediately if inconsistencies are identified.
