← American Academy of Pediatrics (AAP)
CMSRulemakingCMS-2010-0252

Recovery Audit Contractors

RIN
—
Last modified
Apr 21, 2021
Comment window
closed 5678d ago
American Academy of Pediatrics (AAP) filings
1

Activity

American Academy of Pediatrics (AAP) filed 1 comment on this docket between Jan 7, 2011 and Jan 7, 2011. 41 other organizations filed here. The comment window closed 5678d ago.

What American Academy of Pediatrics (AAP) filed (1)

Jan 7, 2011· DC-American Academy of Pediatrics· CMS-2010-0252-0014

Summary of American Academy of Pediatrics (AAP) Recommendations AAP urges the Centers for Medicare and Medicaid Services to include the following in its final rule: Implement an appropriate look-back period for claim review: no more than three years prior to the commencement of a Medicaid RAC review, with no claim paid prior to March 23, 2010 subject to review. Require that all reviews of claims include trained medical professionals with expertise in the medical specialty related to the underlying care or treatment. Control the administrative burden placed on Medicaid providers due to multiple audit programs through coordinated State and Federal oversight and utilization of effective technologies, such as electronic medical records, when applicable. Ensure that contingency fees paid to a Medicaid RAC be made only after any and all appeals related to the recovery amount are concluded and the recovery amount is fully adjudicated. Please see attached files for complete AAP comment letter.

View on regulations.gov →

Abstract

This proposed rule would provide guidance to States related to Federal/State funding of State start-up, operation and maintenance costs of Medicaid Recovery Audit Contractors (Medicaid RACs), and the payment methodology for State payments to Medicaid RACs in accordance with section 6411 of the Affordable Care Act. In addition, this rule proposes requirements for States to assure that adequate appeals processes are in place for providers to dispute adverse determinations made by Medicaid RACs. Finally, the rule proposes that States and Medicaid RACs coordinate efforts with existing contractors and entities auditing Medicaid providers and with State and Federal law enforcement agencies. (The Affordable Care Act requires States and territories to establish a Medicaid RAC program by December 31, 2010. We are proposing that States fully implement and execute the Medicaid RAC program by April 1, 2011. CMS has been working with States to make them aware of the statutory requirements. In fact, a State Medicaid Director Letter was released on October 1, 2010 to give States initial guidance; however, we are requesting publication of theproposed rule as soon as possible.)

View on regulations.gov →

Co-filers (41)

See everyone who commented →
Recovery Audit Contractors (CMS) — American Academy of Pediatrics (AAP) | OpenPolis