In the Tax Relief and Health Care Act of 2006, Congress required a permanent and national RAC program to be in place by January 1, 2010. The national RAC program is the outgrowth of a successful demonstration program that used RACs to identify Medicare overpayments and underpayments to health care providers and suppliers in six states — the demonstration resulted in over $900 million in overpayments being returned to the Medicare Trust Fund between 2005 and 2008 and nearly $38 million in underpayments returned to health care providers.

The goal of the recovery audit program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments:

• Overpayments can occur when health care providers submit claims that do not meet Medicare’s coding or medical necessity policies
• Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B. To assist you with prepararation for an Recovery Audit Contractor (RAC) program audit, the Society has developed a list of conditions that warrant inpatient admission. Download Guidance Criteria (PDF, 70K)

2009

Intensified Audits on ICD Implantation Begin in January (11/06/2009) — The Centers for Medicare and Medicaid Services (CMS) acknowledges that the Recovery Audit Contractors (RAC) Program will intensify their audits on ICD implantations starting in January. To prepare for this increase in audits, heart rhythm professionals are encouraged to learn about the RAC Program and how to prepare your practice for an audit. Learn more »

Society’s Leadership Meets with CMS on Medicare Recovery Audit Contractor Program (04/29/2009) — On April 24, N.A Mark Estes III, MD, FHRS, Richard Page, MD, FHRS, Richard Fogel, MD, FHRS, and Hugh Calkins, MD, FHRS met with the medical directors as well as CMS staff overseeing the Recovery Audit Contractor (RAC) Program to discuss concerns with the audit procedures and to seek feedback and support for the hospitalization criteria developed by the Society. Learn more »

Protests Settled, CMS Resumes RAC Program Implementation (02/11/2009) — The Centers for Medicare & Medicaid Services (CMS) had announced in November that Recovery Audit Contractor (RAC) activities would be temporarily delayed because two contractors that were not awarded the contract protested the agency's decision. On February 6, 2009, the protests were settled and the implementation of the national RAC program has resumed. Learn more »

2008

CMS announces Recovery Audit Contractors for Permanent Program  (10/15/2008) — The Centers for Medicare and Medicaid Services (CMS) announced the four contractors who will each be responsible for a number of states as the Recovery Audit Contractor (RAC) Program expands to all states. HRS is working with CMS and the American Hospital Association to ensure appropriate guidance is followed for identifying when inpatient care is necessary for ICD and CRT-D devices. Audits are now projected to begin early in 2009 and be fully implemented by January 2010. Learn more »

Revised Timeline for Recovery Audit Contractor Program (09/17/2008) — The Centers for Medicare & Medicaid Services announced a revised timeline for implementation of the permanent Recovery Audit Contractor program during a meeting for hospital executives held in Washington, DC. While implementation has been delayed, members should still begin their preparation for the permanent program. Learn more »

CMS Releases Evaluation Report of Entire Three-Year RAC Demonstration (7/16/2008 ) — CMS recently released its final report on the Recovery Audit Contractor (RAC) three-year demonstration, which ended on March 28, 2008. CMS reported at the conclusion of the demonstration that the RAC succeeded in correcting more than $1.03 billion in improper Medicare payments. At a meeting with CMS staff in April, Society leadership disagreed with the RAC's determinations for ICD procedures, and has subsequently developed a list of conditions that warrant inpatient admission status to assist members in preparation for the arrival of the permanent RAC Program. Learn more »

Society Meets with CMS on RAC Program (05/01/2008) — On April 28, 2008, Society leaders met with Centers for Medicare & Medicaid Services (CMS) officials from the Recovery Audit Contractor (RAC) program to discuss concerns with the pilot review process for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) procedures that recently occurred in Massachusetts and New York. Learn more »

Member Advisory-Recovery Audit Contractor (RAC) Program (04/24/2008) — This advisory notice will highlight aspects of the RAC program Heart Rhythm Society members need to be aware of, describe the Heart Rhythm Society’s outreach and education strategies, and assist members with planning for its implementation. Learn more »