Revenue Cycle

AHA weighs in on Part C RACs

Recovery Auditor Report, March 10, 2011

On February 23, the American Hospital Association (AHA) issued a letter to CMS regarding the expansion of recovery audit contractors (RAC) into Medicare Part C and D. Instead of requiring a Medicare Advantage (MA) plan to create a separate RAC program, the AHA urges CMS to implement the Part C RAC program in a manner that focuses on accuracy of payments from Medicare to the MA plans.

In addition, the letter—which did not comment on the Part D RAC program—contained 15 recommendations for CMS regarding the development of the Part C RAC program. These recommendations include:

  • Excluding medical necessity review (MNR) from the program
  • Requiring trained medical professionals to conduct RAC audits
  • Limiting RACs to a 12-month look-back period
  • Necessitating close CMS oversight of RACs and specifically assigning CMS staff to address provider concerns with Medicare Advantage plan RACs
  • Requiring CMS approval of each audit issue before the RAC conducts the audit
View the AHA letter here:

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