The CMS is winding down its recovery audit program with its current contractors, placing the program effectively on hold—perhaps for several months—while it awards new contracts. The pause could be tacit acknowledgment of the need to address issues with the program, a healthcare analyst...
The Centers for Medicare & Medicaid Services (CMS) has taken the next steps in the agency’s comprehensive efforts to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program by awarding contracts to four permanent Recovery Audit Contractors (RACs) designed to guard the Medicare Trust Fund.
Modern Healthcare Coverage of RAC
Appealing bad decisions by Medicare's recovery audit contractors has never been easy. But the system has become so overloaded in recent months that some are calling it an administrative quagmire that is denying basic due process rights because it takes so long.
The advent of recovery auditing in Medicare has led to a sharp increase in administrative appeals by hospitals, creating administrative logjams but not necessarily leading to victories for providers complaining about denied payments.