Corporate Compliance

Q&A: How should providers prepare for Medicaid RACs?

Compliance Monitor, January 5, 2011

Q: How should providers prepare for Medicaid RACs?

A: CMS expects states to fully implement their RAC programs by April 1, 2011. Because the individual states administer Medicaid, the expansion of RACs into Medicaid may in fact prove difficult, says Elizabeth Lamkin, MHA, president of Dalzell Consulting Group, Inc., in Hilton Head, SC.

“We do not know how the RAC contractors will interpret state rules or work with providers,” she explains. “We may see the problems, much as we did in the Medicare demonstration project, based on a learning curve for providers and RAC auditors.”

Providers should prepare for Medicaid RACs by educating themselves on state Medicaid rules and conducting audits on high-volume Medicaid procedures to determine whether bills meet criteria. In the Medicare RAC demonstration project, coding and medically unnecessary services or settings caused most of the overpayments, which providers need to learn from, says Lamkin. “Make this part of your RAC committee work and treat it like the Medicare RAC preparation.”

This week’s question and answer was adapted from the December issue of Medical Records Briefing. For more information about this newsletter or to subscribe, visit the HCMarketplace.

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