Medicaid RAC Audits

What You Need to Know:

Colorado’s Medicaid Recovery Audit Contractor (RAC) process used to be one of the most aggressive in the country. Medicaid RAC audits are a method for ensuring Medicaid payments are appropriately made to health care providers. Over the past several years, Colorado providers and hospitals have identified significant transparency, accountability, and efficiency failures that have led to considerable administrative burden, unwarranted recoupments, and costly litigation activity.

To address this issue, CHA championed HB 23-1295: Audits of Department of Health Care Policy and Financing Payments to Providers, to increase transparency, accountability, and efficiency in this program.

What the Bill Does:

• Requires a comprehensive audit by the office of the state auditor to review Colorado’s Medicaid RAC audit
  practices, including: 
  • Previous audit activity and impact on provider participation and access
  • Models to make providers whole for underpayments
  • The payment models used to reimburse the contractor and impacts on providers
  • The design and effectiveness of other state programs
  • Colorado’s aggressive lookback period
• Requires HCPF to:
  • Hold quarterly provider convening meetings and trainings
  • Create a RAC provider advisory group to advise HCPF
  • Publish audit activity reports on HCPF’s website quarterly, including a summary of audit findings, the RAC contractor contract, scope of work, and HCPF’s supervision of the audits

CHA Contact: Megan Axelrod, vice president, regulatory policy and federal affairs | [email protected]