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CMS Begins Preparing for RAC Expansion to Medicaid

On September 10, 2010, CMS released draft form CMS-10343, which will be used by state Medicaid plans to show that they have contracted with a RAC auditor.  The forms are used in connection with preparation for Medicaid RAC expansion and include criteria related to payments to the Medicaid RAC and the appeal of Medicaid RAC denials.  Under the Social Security Act section 1902(a)(42)(B)(i), States are required to have an operational program and contract with a Medicaid RAC by December 31, 2010.  Pursuant to CMS’s Supporting Statement, States will be able to tailor the Medicaid RAC’s activities to the uniqueness of the Medicaid program in their state, as well as identify and proposetargeted areas for improper payments.

As CMS begins to move towards expansion of the RACs to Medicaid, providers should start preparing for audits of their Medicaid claims.

For more information on RACs or if you need assistance defending a Medicaid audit, please visit– or contract a Wachler & Associates attorney at 248-544-0888.

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