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Medicare Audits and Appeals

Background

Patient protection and Affordable Care Act (ACA): 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.


Sample Recovery Audit Contractor (RAC) letters issued by Medicare Administrative Contractors (MACs)

Sample RAC demand letter
Sample intent to refer letter


MGMA resources


Other outside resources

 
CMS standard forms for filing RAC appeals



 

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