Maria Perrin, the Chief Business Officer for HMS Holdings Corp., recently gave a presentation at the National Medicare-Medicaid Incentives and Penalties Summit near Washington, D.C. In her presentation, “RAC to the Future,” Perrin discussed the future of RACs, with specific focus on four concepts:
- The shifting of delivery models,
- Dual populations,
- Pre-payment reviews, and
- RAC politics.
In her presentation, Perrin noted that as programs shift to managed care and ACO delivery models, RACs may play more of a compliance or safety net role rather than be the primary reviewer of improper payments. Concerning dual-eligibles, Perrin said that CMS pilots might lead to an expanded role for Medicaid and Medicare RACs. With regard to the pre-payment field, Perrin openly questioned whether the scope of RACs will contract, or if any efforts will include RAC-driven information. Finally, Perrin discussed RAC politics, including commentary on the Supreme Court, state legislation, and the dichotomy that public healthcare programs face by serving an expanded population while at the same time auditing providers.
For more information about Medicaid RACs be sure to visit http://www.medicaid-racs.com.