Revenue Cycle

Senate health reform bill expands RAC program to Medicaid, Medicare Parts C and Ds

Patient Access Weekly Advisor, November 25, 2009

Hold on to your stethoscopes, the Senate Healthcare Reform Bill is expanding the RAC program.

Specifically, Section 6411 of the Patient Protection and Affordable Care Act (H.R.3590, p. 1777–1783) broadens the current RAC program to cover Medicare Part C and D as well as the Medicaid program—and all by December 31, 2010.

Similar to the current Medicare RAC program, the Medicaid RACs would be paid by contingency fee to identify under- and overpayments, and would recoup those overpayments. States would contract with one or more RACs to seek out payment errors, and each state must have "an adequate process for entities to appeal any adverse determination made by such contractors," according to the Healthcare Reform Bill.

Read the full report.


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