Medicaid Recovery Audit Contractor Program (RAC Audits)
The ADA works closely with lawmakers, regulators, and others to help ensure the integrity of public health care programs. This includes working with state Medicaid Recovery Audit Contractor (RAC) auditors, who are contracted to identify overpayments and underpayments to health care providers who treat Medicaid patients.
Unfortunately, many well-meaning dentists are receiving significant and sometimes arbitrary fines for unintentional, often minor infractions when there was never any intent to defraud the government.
To enhance program integrity and help grow provider participation in the Medicaid program, the ADA is calling on the Centers for Medicare and Medicaid Services (CMS) to improve the Medicaid RAC audit program by:
- Issuing fair, transparent guidelines to protect dentists from being fined for minor, unintentional infractions, such as those resulting from clerical errors, computer glitches, etc.
- Examining the impact state Medicaid RAC audits have had on dentists who treat Medicaid patients and patient access to dental care.
- Compiling a list of state education and outreach efforts to ensure dentists can function well within the Medicaid program, as required by law.
- Requiring Medicaid RAC auditors to use an in-state dentist to review clinical records, as appropriate.
- Revisiting the method for determining fines to ensure the process is fair and transparent (i.e., the extrapolation method).
The Association's priorities are based on the major policies and positions (PDF) (Members Only) adopted by the ADA House of Delegates.
Letters and Testimony
- July 9, 2014—Letter (PDF) sharing one dentist’s perspective on dental Medicaid Recovery Audit Contractor (RAC) audits with the Senate Special Committee on Aging.
- April 3, 2014—Letter (PDF) urging the Centers for Medicare and Medicaid Services (CMS) to clarify the billing and recordkeeping requirements for the Medicaid Recovery Audit Contractor (RAC) program.
Letters and Testimony reflect the Association's position(s) on specific bills, regulations, and other policy issues, and are based on the major policies and positions (PDF) (Members Only) adopted by the ADA House of Delegates.
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