On January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) will officially implement the Medicaid recovery audit contractor (RAC) program—a very close cousin to the Medicare RAC program. Those states that haven’t already done so, and there are several that have, must hire Medicaid RACs to perform post-payment claim reviews and then identify and recover improper payments.
 

CMS recently released Transmittal 123 (Change Request 6950) on April 30, 2010 on Determining Self-Administration of Drugs or Biologicals which took effect on April 30, 2010. Transmittal 123 provided contractors with updates to manual language related to the determination of self-administration of drugs and biologicals, to allow for other routes of administration besides injections to be considered as not usually self-administered based on some new drugs that were approved by the Food and Drug Administration.

Have you noticed one of the newest features in the MediRegs Coding Suite of products? Under Special Searches on the right hand side tool bar is now a direct link to RAC Issues. Key RAC Resources may be found here, including a direct link to CMS’s RAC information, Region A and B’s index of issues (Mediregs is attempting to secure permission from Regions C and D to post the issues listed on their respective websites), and a summary of RAC issues.

CMS is hosting a Special Open Door Forum teleconference for Part A provider Recovery Audit Contractors (RACs) on April 8, 2009, from 2:00 to 3:30 EST. The purpose of the forum is to introduce providers to the new RACs and provide more information about the RAC program.

CMS notes that capacity is limited; participants may may begin dialing into this forum as early as 1:45 PM EST. Dial: 1-800-837-1935 and reference Conference ID 92490299.