Via: Medicare Proposes to Increase RAC Use

cms-logo-250x100[This article originally published in January 2016]

If CMS has its way, RACs may be expanding the scope of their review to Medicare Advantage claims, and it has published a detailed, 58-point work plan to hire a RAC “to identify underpayments and overpayments and recouping overpayments associated with diagnosis data submitted to CMS by Medicare Advantage Organizations.” In sum, the RAC would conduct risk adjustment data valuation (RADV) reviews, to determine whether all criteria were met prior to setting a RADV score to a patient, thereby determining the reimbursement value based on risk.

via Medicare Proposes to Increase RAC Use: Recovery Audit Contractor

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