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Recovery Audit Contractors (RACs) Resource Center

About RACs

RACs identify overpayments and underpayments made by CMS to providers. CMS has not yet released 2010 Part B medical records limitations. 

Patient Protection and Affordable Care Act (PPACA): Expansion of the RAC program  

• After 2010, HHS shall contract with RACs to ensure that each Medicare Advantage plan under Part C and each Prescription Drug Plan under Part D have an effective anti-fraud plan in place.
• Before 2011, state Medicaid agencies must contract with one or more RACs, which will identify underpayments and overpayments, and recover overpayments made for services provided under state Medicaid plans as well as state plan waivers.

For detailed information regarding RAC provisions, visit the PPACA implementation reference guide.  

To help prepare your practice, MGMA offers the following resources;

• Preparing Your Practice for the RACs, on-demand Webinar
  
  
• CMS RAC map shows the RAC expansion schedule and permanent contractors 
  
  
• Read the CMS, MLN Matters article regarding RAC Demonstration High-Risk Vulnerabilities – No or Insufficient Documentation Submitted
  
  
• Read the March 9, 2009 letter MGMA and 101 national and state medical associations sent to CMS regarding concerns with the RAC expansion 
  
  
• FAQs about the Medicare RACs
  
  
• RAC FAQs from CMS  

Find Your Contractor

RAC Background and History

In October 2008, CMS announced the four entities that received national RAC contracts. Soon after, two entities that lost bids to become RACs filed protests with the General Accountability Office (GAO), challenging the way CMS awarded the contracts. On Feb. 6, 2009, CMS announced it had resolved the contracting protest and lifted the stop-work order imposed on the RACs.

The permanent RAC program evolved from the three-year RAC demonstration project stipulated by the Medicare Modernization Act (MMA) of 2003. The Tax Relief and Health Care Act (TRHCA) of 2006 made the RAC program permanent and authorized CMS to expand it to all 50 states by 2010.

Unlike the demonstration project, the permanent RAC program limits the medical-record review period to three years and prohibits audits on claims paid before Oct. 1, 2007. The program requires RACs to have a physician medical director and certified coders available to discuss denials with providers. RAC auditors must provide clinical credentials to providers upon request.

CMS also announced the number of medical records RACs may request per National Provider Identifier (NPI) for 2009. CMS will likely adjust these limits each year.

For Part B providers, the 2009 limits are:

• 10 medical records per 45-day period for solo practitioners 
• 20 medical records per 45-day period for two to five provider offices 
• 30 medical records per 45-day period for groups of six to 15 providers 
• 50 medical records per 45-day period for groups of 16 or more providers

For Part A claims, the 2009 maximum number of records RACs may demand varies by the hospital’s NPI and will equal 10 percent of their average monthly Medicare claims. The RACs cannot request more than 200 records in a 45-day period for both inpatient and outpatient claims combined.