RAC demonstration reviews begin after June 1

After a six-month delay, CMS just announced that the Recovery Audit Prepayment Review will move forward after June 1.

The review (a demonstration project) will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments.

The demonstration is part of CMS’s crackdown on waste and fraud.

The reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO).

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