Recovery Audit Contractor Program
RAC audits may only review claims that are no more than 3 years past the date of the expiration of the timely filing period. The bill allows the state department to review claims that fall outside of this 3-year time frame only if required by a federal audit.
The bill limits the number of audits a provider may undergo each year and limits the number of medical records that can be requested for a given audit.
If the state department identifies preliminary findings during the RAC audit, the state department must send the provider a report detailing the preliminary findings, the rationale for the preliminary findings, and the methodology for how any overpayments were calculated and determined.
The bill allows a provider that received preliminary findings following a complex audit to request an exit conference to discuss the preliminary findings with the state department in an effort to resolve the concerns detailed in the preliminary findings prior to undergoing an informal reconsideration of the preliminary findings.
The bill requires a provider to participate in an informal reconsideration before filing a formal appeal regarding the state department's findings during a RAC audit.
The bill, in the department of health care policy and financing for medical and long-term care services for medical-eligible individuals budget, decreases the cash funds appropriation from recoveries and recoupments by $20,900,588 and the cash funds appropriation from the recovery audit contractor recoveries cash fund is increased by $20,900,588.
(Note: This summary applies to this bill as introduced.)