MHCP Announces HMS as RAC
The Patient Protection and Affordable Care Act (ACA) requires Minnesota Health Care Programs (MHCP) to contract with a Recovery Audit Contractor (RAC) to audit payments made to MHCP providers.
Our Office of Inspector General has contracted with HMS as its RAC. The RAC program is designed to support program integrity and supplement existing post-payment claims review processes. HMS will focus on identifying underpayments and assist MHCP in recovering overpayments made to fee-for-service providers.
HMS will review provider claims to determine if improper payments have occurred by conducting:
- Clinical and coding reviews
- Onsite and desk audits
- Data verification
The Surveillance and Integrity Review Section (SIRS) at DHS will oversee HMS and coordinate reviews with other audit and investigative efforts. MHCP providers continue to be subject to other post-payment reviews conducted by SIRS, by the MHCP medical review agent, and under the Payment Error Rate Measurement (PERM) program.
Impact to Providers
HMS anticipates sending the first audit letters to hospital providers in May 2013, focusing on inpatient and outpatient hospital billing. Future mailings will include other provider types.
Providers who receive an audit request will be given access to the HMS web portal where they can check the status of their ongoing audit and get other information. Providers who disagree with audit findings may seek reconsideration from HMS and appeal any final determinations through the contested case hearing process. After a final determination is made, MHCP will take back overpayments identified by the audit. MHCP is developing a web page that will include a link to the HMS web portal, appeal information, sample audit letters and frequently asked questions (FAQs) about HMS and the RAC program.
Contact Information
- Providers with general questions about RAC matters can email DHS.RAC@state.mn.us
- Providers with specific questions about an ongoing audit can call HMS Provider Services at 1-855-394-8063
- RAC webpage (available soon on the MHCP Enrolled Providers website)
Additional Resources
If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 1-800-366-5411.
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