Corporate Compliance

Four claim RACs announced

Medicare Weekly Update, October 14, 2008

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The big news last week was the announcement of the four Claim RACs (i.e., claim review contractors) for the permanent RAC program. Two of the Claim RACs (Connolly and HDI) were Claim RACs for the RAC demonstration program. Interestingly, one of the Claim RACs (PRG-Schultz, the Claim RAC for California and Arizona) for the demonstration program was not awarded a contract under the permanent program. If you would like to see which Claim RAC has jurisdiction over your state and the expected start date, check out the recently updated "RAC Expansion Schedule."

You might also be interested in knowing the contingency fee percentages that will be paid to the Claim RACs contractors under the permanent program. Prior to last week, that information was confidential. However, last Friday, CMS published the contingency fee percentages. The contingency fees range from 9% to 12.5%.

Finally, if you haven't had a chance to review the latest version of the CMS's evaluation report on the RAC demonstration program, you can download a copy. Pay careful attention to Appendix G. It lists the "Top Services with Overpayments," which are the most significant payment errors uncovered by the Claim RACs during the demonstration program.


 



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