Corporate Compliance

CMS provides updated RAC numbers

Healthcare Auditing Weekly, September 30, 2008

CMS released an updated evaluation of its recovery audit contractor (RAC) program, which shows statistics through June 2008.
The first evaluation, released in July 2008, included information through March 27, 2008. In the report, CMS says it will continue to update the evaluation through the fall of 2008, with a complete update slated for late 2008 or early 2009.
The newest evaluation contains the following statistics on claims RAC determinations:
·        525,133 – claims with overpayment determinations
·        102,705 – claims providers appealed
·        35,819 or 34.9% – claims with appeal decisions in providers favor
·        6.8% - claims overturned on appeal
·        1,607 – claims pending at the administrative law judge (ALJ) level
As required by Section 302 of the Tax Relief and Health Care Act of 2006, CMS is set to roll out the permanent RAC program by 2010. CMS plans to have four RACs in place, each responsible for a quarter of the country. For more information on the permanent program, including an expansion schedule, click here.


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