Regarding “Proposed rule offers states pay options for Medicaid RACs
It will be interesting to see how this one works out. Most recovery audit contractors are selected via lowest-priced bids. Fees paid to RACs are very low; waiting for payment may cause budget issues for RACs. Add to this the appeals process. It's lengthy. Will RACs want to continue with this program if they know payment will take up to a year or more?
I’d also offer this, because of the way contractors are selected, those who could actually recover monies for the CMS would never be in a position to act as RACs. In my opinion, current RACs will have limited success in recovering revenue because they don’t understand the underbelly nuances of the industry. I have long said, recovery, as it was intended, can only be obtained through the contracting of firms or individuals who have worked in the roles of provider and consultant. We shall see.