The Centers for Medicare and Medicaid Services on Sept. 16 published the final rule to establish the Medicaid Recovery Audit Contractors program.

The initiative is modeled after Medicare's RAC program, which the Obama administration says has recovered $670 million in overpayments during 2011 during its rollout phase. The administration estimates Medicaid RAC will save $2.1 billion over five years, with $900 million being returned to states.

Some providers are finding that use of data analysis and reporting software has eased management of the Medicare RAC program. The software, for instance, can import data from claims systems to generate reports on the status of audits, analyze the organization's financial risks and help pinpoint areas of the coding, physician documentation and billing processes that need improvement. Such software, for instance, can identify which DRGs were predominately overpaid.

 

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