HHS Medicad RAC Final Rule

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The U.S. Department of Health and Human Services (HHS) issued its final rule on the Medicaid RAC program. The program allows states to hire Recovery Audit Contractors to assess underpayments and overpayments in unemployment insurance. HHS hopes the program will save $2.1 billion in waste over the next ten years.

The rule is effective January 2, 2012, and gives guidance to states about federal and state funding for the start-up, operation, and maintenance costs of Medicaid RAC contractors and the payment methodology for state payments to Medicaid RACs. It also directs states to ensure that proper appeal processes are in place for providers to dispute “adverse determinations” from the contractors.

Read the final rule here.