Not All Medicaid RACs Are Alike

One provision of the Affordable Care Act requires state Medicaid agencies to contract with a Recovery Audit Contractor (RAC) to identify and recover Medicaid overpayments and underpayments. While these audits may be necessary, they shouldn’t interfere with your primary goal of caring for your patients.

HMS has been working with Medicaid providers since 1985. As an experienced vendor in Medicaid overpayment recovery, we understand the potential burden these audits can cause for providers. Our emphasis is on making the process easy for you, so you can stay in compliance while focusing on your real job.


What to Expect

Here’s our “Top Six” list of what you should expect from any RAC contractor — and why HMS delivers with a difference:

  1. A full understanding of every aspect of the audit process — right from the start. We conduct face-to-face meetings and conference calls with hospitals and provider associations, and individual providers. We work with multiple contacts at your facility to make sure that everyone has a common understanding of the process and objectives.

  2. A 24/7 state-of-the-art web-based portal to help you navigate the overpayment identification and recovery process—without the burden of paper. Through our Provider Portal, claims targeted for potential overpayments are delivered electronically, and can be accessed at your convenience. You can also respond to requests, submit questions, update contact information, and more. Our Portal also simplifies the self-disclosure process. Today, over 26,000 providers use our Provider Portal to help them manage the audit process.

  3. A full-time Provider Services team to guide you through the audit process. Our team is focused exclusively on responding to your inquiries, and has the experience required to promptly and accurately respond to your questions regarding the review and recovery process. Our Call Center handles approximately 23,000 calls every month, and we accommodate time zones across the country.

    Your medical records and other documents are safe with HMS. When you send them to us, they do directly into our content imaging system, where they are highly secured and ready for prompt processing.

  4. Regular updates on findings. We regularly participate in state hospital and provider association meetings and publish information about trends and issues identified on our website. We also publish quarterly newsletters and conduct webinars to keep you up to date.

  5. A highly skilled Clinical Review team. Registered nurses, certified coding professionals, and physicians experienced in the review of medical records work together to review claims and make fair determinations based on your state’s policy and regulations. Our audit expertise crosses all Medicaid service types, including hospital, long term care, pharmacy, DME, and behavioral health.

  6. Guidance on how to correct overpayment errors in the future. Provider education is important to us. Our determination letters include detailed clinical rationales so you’re 100% clear on why a claim is denied, and how to prevent the overpayment on future claims.

Our goal is to serve providers with excellence and integrity. Today, providers across the country rely on HMS as a trusted partner for expertise and guidance.

Provider Comments on Draft Medicaid RAC Rules & CMS Response


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