In the Tax Relief and Health Care Act of 2006, Congress required a permanent and national Recovery Audit Contractor (RAC) program to be in place by January 1, 2010. The goal of the RAC Program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. The RACs review claims on a post-payment basis, and they can go back three years from the date the claim was paid. To minimize provider burden, the maximum look back date is October 1, 2007.
Recoupment (under the provisions of Section 935 of the MMA) can begin no earlier than the 41st day from the date of the first demand letter, and can happen only when a valid request for a redetermination has not been received within that period of time.
Under the scenario just described, the RAC has to report the actual recoupment in two steps:
- Step I: Reversal and Correction to report the new payment and negate the original payment (actual recoupment of money does not happen here);
- Step II: Report the actual recoupment.
CMS has learned that it is not providing enough detail currently in the RA to enable providers to track and update their records to reconcile Medicare payments.
CR 6870 instructs the Medicare System Maintainers (Fiscal Intermediary Standard System â€“ FISS and Multi Carrier System â€“ MCS) how to report on the RA when:
- An overpayment is identified, and
- Medicare actually recoups the overpayment.
The refund request is sent to the debtor in the form of an overpayment demand letter, and the demand letter includes an Internal Control Number (ICN) or Document Control Number (DCN) for tracking purposes that is also reported on the RA to link back to the demand letter.