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RAC Audit Overview

RAC is an acronym for recovery audit contractor. RAC represents an effort to audit health care providers on behalf of Medicare and Medicaid to ensure health care providers are not overbilling Medicare and Medicaid. The Centers for Medicare & Medicaid Services oversees the programs.

RAC Audit Preparation

The CMS selects recovery audit contractors to perform audits at provider facilities. The CMS pays RAC contractors on a contingency basis, which means they are only paid when they find overpayments or potential fraud. For this reason, health care providers must have their records and accounting system in order; this protects them from an audit in which RAC contractors may be extremely aggressive in looking for problems. Third-party organizations provide audit preparation software to help health providers organize their records and prepare for an RAC audit.

Benefits of RAC Audits

According to the CMS, recovery auditors identified $2.4 billion in improper Medicare payments in the 2012 fiscal

year. This resulted in the collection of $2.3 billion in overpayments made health care providers; underpayments came to approximately $109 million.


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