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CMS Awards New Recovery Audit Contracts

The Centers for Medicare and Medicaid Services (CMS) recently moved forward to award the second round of the national Recovery Audit Contractor (RAC) program contracts, extending the vital program that identifies and returns Medicare improper payments back to the Trust Funds. Five new contracts have been awarded—four regional contracts and one for a new region focused solely on auditing DME/HH-H claims nationwide. The contracts have been awarded to the following:

Region 1                               Performant Recovery, Inc
Region 2                               Cotiviti, LLC
Region 3                               Cotiviti, LLC
Region 4                               HMS Federal Solutions
DME/HH-H                            Performant Recovery, Inc

With the financial future of the Medicare program in a precarious position, it's more important than ever for RACs to be back at work actively recovering misspent Medicare funds to extend the life of the program. Recently, Medicare Trustees raised concerns that at current spending levels, the program will be insolvent by 2028—two years sooner than previously reported.

Congress mandated the creation of the RAC program to review Medicare claims, identify billing errors and return misbilled funds back to the Medicare Trust Fund. Since the program began in 2009, RACs have returned more than $10 billion in improper payments to the Trust Fund and more than $800 million in underpayments to providers. Recovery auditing has been credited with extended the life of the Medicare program by two full years.

"We are pleased to see these important contracts awarded, marking the beginning of a new phase of Recovery Auditing work and demonstrating a renewed commitment to reducing improper payments in Medicare," says Kristin Walter, spokesperson for the Council for Medicare Integrity. "Medicare loses more money to waste than any other federal program, with a billing error rate well above the legal threshold of 10% for the past three years in a row. With Medicare's solvency in serious jeopardy due to a loss of more than $150 billion in taxpayer dollars over the last three years, renewing the work of the RAC program to balance the program's checkbook is essential to protecting Medicare's future fiscal health. Now, auditors can to get back to the important work of reducing improper payments, which ultimately protects American seniors' long-term access to health care."

For more information, visit www.medicareintegrity.org. 

Source: Council for Medicare Integrity