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Recovery Audit Contractor (RAC) Program - Region C
This site contains resources regarding RAC contractors.
AHA Expresses Concerns with Veterans Affairs’ Third-party Audit and Appeals Process
AHA members have expressed significant concerns about Cotiviti’s audit and appeals process, including its inadequate appeals procedures, the scope of audits being performed and the untenable timelines that are being executed. Therefore, we urge the VA to issue proposed rulemaking not only to allow for public input but also to formalize clear standards and expectations governing the audit and appeals processes.
Litigation: AHA, Hospitals Sue to Require HHS to Meet Deadlines for Deciding Appeals
Appeals court sends order to eliminate backlog of Medicare appeals back to trial court (August 11, 2017)
Litigation
This page contains materials related to AHA’s current and active policy-related litigation.
Eliminating Racial and Ethnic Disparities - Assessment and Planning Toolkit
A Toolkit for Collecting Race, Ethnicity and Primary Language Information From Patients
RACs - Recovery Audit Contractors
The AHA continues to work with government stakeholders to improve the RAC program and prevent abuses that prevent hospitals from receiving payment for necessary medical care.
Program Integrity
In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments.
AHA to CMS Regarding Suspension of Medical Review Activities
AHA urges the Centers for Medicare & Medicaid Services to continue its suspension of medical review activities throughout the ongoing COVID-19 public health emergency.
CMS highlights actions to reduce RAC-related complaints, appeals
In a blog post today, Centers for Medicare & Medicaid Services Administrator Seema Verma highlights recent progress in reducing provider complaints related to the Medicare Recovery Audit Contractor program and associated backlog of appeals.
CMS approves limited Utah Medicaid expansion with work requirement
The Centers for Medicare & Medicaid Services Friday approved a Section 1115 waiver allowing Utah to amend its Primary Care Network demonstration to provide Medicaid coverage to adults under age 65 with incomes up to 100 percent of the federal poverty level, and require certain adults in the program to register to apply for work to remain eligible.