The passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010 significantly altered the regulatory landscape for the U.S. healthcare industry. Among other key provisions, the expansion of Recovery Audit Contractor (RAC) audits raises expectations for efficiency and accountability for healthcare systems of all sizes.
Building upon previous legislation that established the RAC audit program, PPACA requires states to engage a RAC contractor to review Medicaid reimbursements, and extends the RAC program scope to include Medicare Parts C and D. This presents a number of challenges for healthcare providers:
The complexity of managing the process, coupled with the larger amount of possible audit requests, demands that providers invest additional resources in responding to record requests, compiling appeals, and managing deadlines.
Missed deadlines or submission of incomplete evidence may require repayment of Medicare or Medicaid funds.
Providers may lack the necessary tools for analyzing audits and gaining insights that can help them remain compliant with RAC initiatives.