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Medicare RAC Audit Management
Medicaid RAC Audit Management
How to successfully manage Medicare & Medicaid Audits
MIC Audit Management
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Healthcare - Medicaid RAC Audits
The Affordable Care Act of 2010 required States and territories to establish Medicaid Recovery Audit Contractor (RAC) programs. The Medicaid RAC program is expected to operate in a manner similar to that of the existing Medicare RAC program, i.e., audit contractors are paid on a contingency basis to identify and recover Medicaid overpayments, as well as, underpayments.
On September 14th, 2011, the Centers for Medicare & Medicaid Services(CMS) announced the final rule for the Medicaid RAC Program scheduled to take effect on January 1st, 2012. The Medicaid RAC program is not expected to replace the existing MIC program and CMS has stated that while they hope to minimize the likelihood of overlapping audits, they still may be necessary. As if dealing with overlapping audits weren't enough, the rule also calls for states to either utilize an existing appeals process, presumably from their current MIC programs, or adopt an entirely new appeals process. Regardless of which appeals process is selected, it is most likely to differ from the existing Medicare RAC appeals process and differ from state to state.
So what is a healthcare provider to do? One option that is already proving successful with concurrent Medicare RAC and MIC audits is to take control with a single robust software application capable of handling the complexity and volume of many different claims audit types each with different time frames, deliverables, and appeals processes.
Using Compliance 360 to Manage Medicaid RAC Audits
The Compliance 360 Claims Audit Manager helps healthcare providers manage a wide variety of medical claims audits and appeals, including Medicaid RAC audits. Claims Audit Manager is part of the industry leading Compliance 360 solution for healthcare that enables a comprehensive approach to regulatory compliance and risk management through one comprehensive, enterprise-wide platform.
With the Compliance 360 Claims Audit Manager for Managing Medicaid RAC Audits, you can:
With Compliance 360, you can manage the entire Medicaid RAC audit process, from the initial receipt of a request for records, through your State appeals process and adjudication. You can also establish efficient projects for managing proactive self-audits. Using random samples from your claims history, based on the high risk targets of the Medicaid RAC Auditors, you can quickly assess your financial and legal risks. Armed with this information, you can make informed decisions regarding self-disclosure which often results in favorable treatment such as reduced or eliminated interest and penalties in many states. As an example of the potential favorable treatment for self-disclosure, see the State of New York OMIG Self-Disclosure Guidance.
To learn how other healthcare organizations are using Compliance 360's Claims Audit Manager, we invite you to download the following case studies:
If you'd like to request a personal demonstration of the Compliance 360 Claims Auditor, please Contact Us.
Free Medicaid RAC Audit Training (On-Demand Webinars)
You are also invited to attend our live broadcasts or replay our on-demand recorded training webinars at your convenience. These training webinars have been attended by more than 10,000 participants and have received very positive feedback. Click Here for the full list of live and on-demand training webinars.
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