Federal officials have agreed that Medicare’s Recovery Audit Contractor (RAC) program needs to be revised, saying the problem lies with the third level of Medicare appeals. Currently, a backlog of 460,000 appeals are pending for administrative law judge hearings. Officials say that clearing the backlog would take 10 years and that providers’ payments could be stopped while an appeal is underway. An official from the Office of the Inspector General believes that the RAC program has not been properly evaluated because appropriate metrics have not existed. In February, CMS prevented RACs’ ability to request documents for claims reviews until new RAC contracts were procured.
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