But program may not reach full swing until next year

While Jan. 1 was the official launch date for Medicaid RAC audits, it will probably take at least a year for the program to get up and running, according to RAC specialist Sandy Newstein.

“Jan. 1 was the implementation date for having a signed contract in place with a RAC vendor, but there will most likely be a waiting period before we see request letters,” said Newstein, senior consulting manager for Chadds Ford, Pa.-based IMA. “It could be a year, or even 18 months, before we see anything major – it takes vendors some time to assimilate the data that comes to them and get the staff ready to handle the volume.”

The Medicaid RAC audit program shares some similarities with its Medicare RAC counterpart, but it also has some stark differences – namely a state-administered format. While the federally-run Medicare RAC program uses a lengthy “statement of work” document to describe the program, each state will have its own individual document.

“The Medicare ‘statement of work’ may be overly long, but at least it stands alone,” said Newstein. “Going state to state, information is hard to obtain. For something as simple as finding out who the RAC contractor is for a particular state, you have to dig for the information.”

For instance, Georgia doesn’t even have a RAC contractor because it is seeking an exemption from the Medicaid RAC program. “Until that is settled, there is not a lot happening here,” said Laura Van Yush, RN, RAC coordinator for DeKalb Medical Center in Decatur, Ga.

Republican Gov. Nathan Deal, meanwhile, is said to be opposed to the Medicaid RAC program and the Affordable Care Act. Last May, Georgia Health News reported that the governor vetoed a state House bill establishing the RAC program for Medicaid because the legislation “would significantly impair Georgia’s ability to detect and deter fraud and abuse within its Medicaid program [and] would eliminate an effective option of detecting overpayments.”

RAC resources

There are various sources of information about the Medicaid RAC program on the Internet, including an 18-page frequently-asked question document on the CMS website (CMS.gov) and a website called Medicaid-RAC.com.

The CMS FAQ section is “the best source of information I’ve seen,” Newstein said.

A sample question from the document asks: “What should a state do to prepare providers for the Medicaid RAC audits and will providers need to implement new compliance procedures?”

CMS responds: “A State should be as informative as possible about the implementation of its Medicaid RAC program. Information furnished to providers should include, at a minimum, the name and contact information of the RAC vendor selected by the State, when the RAC will begin working to identify overpayments and underpayments, and a general description of the scope of its RAC program.

“We do not expect that providers will have to undertake any major activities to prepare for Medicaid RACs,” the response continues. “Providers may need to identify a point of contact, be aware of deadlines, prepare medical records, familiarize themselves with Medicaid coverage guidelines, as well as educate staff.”