The CMS faces some challenges ahead in expanding the Recovery Audit Contractor program to all of Medicare and to Medicaid by the end of year, an agency representative told a Senate panel.
The RAC program allows third-party auditors hired by the CMS to keep 9% to 12.5% of provider payments they identify as improper. Currently, it conducts audits only in fee-for-service Medicare, but provisions in the new reform law call for an expansion of the RAC program to Medicare Parts C and D and Medicaid by Dec. 31.
Such a task will not be easy, admitted Deborah Taylor, director and chief financial officer of the CMS' Office of Financial Management, who testified before the Senate Homeland Security and Governmental Affairs' Subcommittee on Federal Financial Management, Government Information, Federal Services and International Security.
Phasing in RAC audits for Medicare Advantage “is going to be tougher for us,” given that the CMS already has a contractor that gets paid to conduct audits for Medicare Part C, she said. “We don't want to duplicate our efforts.”
The challenge with Medicaid is dealing with more than 50 different programs, with most states in need of resources to start up RAC-like audits, Taylor said.
(For more on this topic, please see our Recovery Audit Program section.)
