Recovery Audit Contractor (RAC)
■ OUR RAC PROGRAM IS A UNIQUE APPROACH THAT CAN BE CUSTOMIZED
TO ENHANCE YOUR PROGRAM INTEGRITY UNIT
The RAC final rule (42 CFR § 455) provides a series of directives for states to implement and maintain the Medicaid RAC program. The rule also allows flexibility for states to build a RAC model that enhances current program integrity services beyond their current activities. Myers and Stauffer’s Recovery Audit Contractor (RAC) solution is designed to fulfill both the mandatory requirements of the RAC rule but also provide the flexibility that states need to enhance program integrity while avoiding duplication of current program integrity activities.
Myers and Stauffer is qualified, experienced and ready to fulfill the requirements.
- High Quality Technical Capability: Myers and Stauffer has worked closely with State Medicaid agencies on difficult reimbursement and program integrity issues for 35 years.
- Superior Staffing Solutions: Myers and Stauffer employs the required Medical Director and Certified Professional Coders but the firm’s diverse staffing mix also includes Registered Nurses, Licensed Practical Nurses, Certified Fraud Examiners, Certified Public Accountants, Pharmacists and many others. In addition, Myers and Stauffer can provide access to a network of specialists (e.g. Dentists, Surgeons, Internists, etc.) and can also provide other unique staffing expertise (e.g. statistical support, actuarial support and legal analyses) as needed.
- Maximum Customer Service: While the Medicaid RAC rule requires a minimum level of customer service, the Myers and Stauffer approach is to provide solutions that not only fulfill the minimum requirements but can also include enhancements like online provider portals, online capability for providers to update their contact information, and electronic case management.
The Myers and Stauffer RAC solution is designed to not only analyze and recover overpayments on Medicaid fee-for-service claims but can also be customized to include:
- Analysis of managed care encounters and assistance with recoveries.
- Analysis of Children’s Health Insurance Program (CHIP) claims and recovery of overpayments.
- Credit balance auditing solutions.
- Other creative and unique program integrity auditing solutions tailored to your needs.