CMS Adding 5th RAC: Medicaid Audits Expected to Increase

It is wise to worry about tomorrow today.  -Aesop’s Fables, “The Ant and the Grasshopper”

CMS has announced that it will add a 5th Medicare RAC to focus on home health and durable medical equipment (DME).  Obviously, with the aid of a 5th RAC, the other RACs will have more free time to focus on other health care providers.

So what does a 5th RAC for Medicare mean for Medicaid in North Carolina.  First, many providers that accept Medicare also accept Medicaid.  The two programs do have some commonality.  Also, NC started out with one RAC.  As the federal government increased the number of RACs, NC has slowly increased the number of RACs.  We started with Public Consulting Group (PCG) in January 2012 and added HMS October 2012.  Then, of course, we have The Carolina Centers for Medical Excellence (CCME), approved through an RFP, performing “Quality Improvement Strategy functions” on the behalf of DMA.

Expected Future for NC Medicaid Providers?  More and more and more and more audits.

Remember the ant in the “Ant and the Grasshopper?” If not, here is the fable.

Quick Synopsis: All summer long the grasshopper played while the ant dutifully collected food for the winter, while the grasshopper made fun of him.  Once winter came, the grasshopper had no food, and the ants says, “You should have thought of winter then!”

So, providers, be the ant!

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on May 16, 2013, in CCME, CMS, DHHS, Division of Medical Assistance, Durable Medical Equipment, Health Care Providers and Services, HMS, Medicaid, Medicaid Audits, Medicare RAC, North Carolina, PCG, RAC, RAC Audits, Reconsideration Reviews, Regulatory Audits, Tentative Notices of Overpayment and tagged , , , , , , , , , . Bookmark the permalink. Leave a comment.

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