RAC Solutions ( Recovery Audit Contractors )

Have you considered how the RAC will affect your organization. The time to act is now. SSI has a product that can help you track and respond to RAC but you need to act now. ClickON® RADS ( Revenue Audit Defense System ) can be installed to help with your workflow through the auditing process. If you delay you may pay.

Call us today to find out more about this new product. 1-800-881-2739
Or click here to view our ClickON® RADS product information.   -   ClickON® RADs Product Workflow

What is Recovery Audit Contractors ( RAC )?
RAC is a Medicare auditing program that utilizes private firms to examine physician, hospital, nursing home, and other claims to find instances in which the government has overpaid providers. According to a recent status report by the Centers for Medicare and Medicaid Services (CMS) the existing RAC had recovered $303.5 million in improper payments since the spring of 2005. CMS has recouped $68.6 million in overpayments from providers, including physicians, hospitals, durable medical equipment (DME) suppliers and labs, for alleged unnecessary services, improper coding and secondary payer issues. It is expected that CMS will recover another $294.5 million in identified overpayments from providers in the future.

According to CMS, the RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers. It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments.

Under the program, the four RACs will contract with subcontractors to supplement their efforts.  PRG-Schultz, Inc. will serve as a subcontractor to HDI, DCS and CGI in regions A, B and D.  Viant Payment Systems, Inc. will serve as a subcontractor to Connolly Consulting in region C.  Each subcontractor has negotiated different responsibilities in each region, including some claim review.   

The RAC in each jurisdiction is as follows:

Region A:  Diversified Collection Services (DCS) 

Region B:  CGI

Region C:  Connolly, Inc.

Region D:  HealthDataInsights, Inc.

All correspondence, websites and call centers will be in the name of the RACs above.

RAC Permanent Program:  Section 302 of the Tax Relief and Health Care Act of 2006 made the RAC Program permanent and required the Secretary to expand the program to all 50 states by no later than 2010. .

Each RAC is responsible for identifying overpayment and underpayments in approximately ¼ of the country. The RAC jurisdictions match the DME MAC jurisdictions.  See below for a link to the RAC Jurisdiction Map.