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Services > RAC (Recovery Audit Contractors) Reviews

Learn more about RAC reviews at the Centers for Medicare & Medicaid Services


What are RAC audits?

Purpose: to detect and correct past in proper payments so that CMS carriers, Fiscal Intermediaries (FI) and Medicare Administrative Contractors (MAC) can implement actions that will prevent improper payments.


Why conduct a Pre-RAC readiness review?

  • Identify potential errors and areas of vulnerable risk
  • Review current systems for “best practices”
  • Identify opportunities of education and training needs
  • Examine methods of communication between Nursing, Therapy and Billing, etc.
  • Review reimbursement structure


Services > MIC (Medicaid Integrity Contractors) Reviews

Learn more about MIC reviews at the Centers for Medicare & Medicaid Services


What are MIC audits?

Purpose: Deficit Reduction Act of 2005 (Section 136 of the Social Security Act) provided for the creation of the Medicaid Integrity Program (MIP) and increased the federal government’s role and responsibility in combining medical fraud and waste and abuse. Section 136 of the Act requires CMS to enter into contract with MICS.


Why have a MIC readiness review?

  • Identify potential errors and areas of risk
  • Review current compliance practices
  • Review communication systems between nursing, therapy and billing
  • Review reimbursement structure
  • Identify educational and training needs

Which providers will be subject to audit?

Any Medicaid provider may be audited, including but not limited to, the fee-for-service providers, institutional and non-institutional, as well as managed care entities.

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