RAC is an acronym that stands for the Recovery Audit Controller. This is a program that was created in the year 2003 under the Medicare Modernization Act of 2003. It has the role of identifying and recovering of the improper payments in the medical field. These are payments usually remitted to the healthcare providers under the required fee – for – service (FFS) Medicare Plans ( Dimock, Stuart, Padmanaban & Elkin, 2013) . However, AMA is very much opposed to the contingency fee structure placed in use by RAC and has been in the forefront to advocate for numerous alterations to be made on the same. These improvements have been successful and have played an important role in the entire development of the program.
The mission of the program is to correct and identify incorrect and improper payments in the medical field through the application of efficient collection and detection of overpayments that have been made on the health care services claims especially those submitted to Medicare beneficiaries ( Taylor, 2014) . It also aims at the identification of underpayments made to the health care providers in order to ensure that the CMS is in a position to implement the relevant actions that would be very significant in the prevention of future improper and incorrect payments in all of the 50 states in America.
Delegate your assignment to our experts and they will do the rest.
The historical background regarding RAC is based on the fact that it is a product of a very successful and important demonstration program that has indeed used the recovery auditors in its plight to help and identify the Medicare underpayments and overpayments to the health care providers plus the suppliers in some states that are often selected randomly. This demonstration was undertaken between the years 2005 and 2008 and a whopping $ 900 million was returned to the Medicare kitty as overpayments. Another $ 38 million was also returned as underpayments to the health care providers ( Dimock, Stuart, Padmanaban & Elkin, 2013) . The secretary to the Department of Health and Human Services was then required to institute a national and a permanent Recovery Audit Program to recover the overpayments linked to the services where payment were made under part A or B of the Title XVIII based on the Social Security Act. This provision was closed under Section 302 of the Tax Relief and Health Care Act of 2006. This requirement was placed by the Congress. Indeed, each recovery auditor has the role of identifying the underpayments and the overpayments of payments in over 25% of the country. These recovery programs and jurisdictions resemble those of the DME MAC jurisdictions.
There are indeed four regions demarcated for the provision and implementation of the program. These regions are named from A to D and each region has a specific auditor ( Taylor, 2014) . Region A is audited by Performant recovery and covers areas such as Delaware, Maine, District of Columbia, Connecticut, Maryland, New Jersey, New Hampshire, Massachusetts, Vermont, New York, Rhode Island, and Pennsylvania. Region B is audited by CGI Federal, Inc. and cover areas such as Wisconsin, Ohio, Minnesota, Kentucky, Michigan, Indiana, and Illinois. Region C is audited by Connolly, Inc. and covers areas such as Alabama, Florida, Georgia, Colorado, Arkansas, Louisiana, New Mexico, Oklahoma, North Carolina, Mississippi, West Virginia, Virginia, Tennessee, Texas, and South Carolina. Finally, region D is audited by HealthDataInsights, Inc and covers areas such as Alaska, California, Iowa, Idaho, Hawaii, Arizona, Kansas, Montana, Nebraska, Nevada, Missouri, North Dakota, Oregon, Utah, South Dakota, Wyoming, and Washington. Indeed California state is in region D and is audited by HealthDataInsights, Inc.
References
Dimock, R. A. C., Stuart, S., Padmanaban, V., & Elkin, S. (2013). P64 The impact of simple interventions on oxygen prescribing and monitoring: Audit of oxygen management in Central London Teaching Hospital. Thorax , 68 (Suppl 3), A103-A104.
Taylor, M. (2014). Hospitals whacked by RAC. The audit program imposes a crushing burden on hospitals. Can it be fixed?. Trustee: the journal for hospital governing boards , 67 (3), 15.
