OIG RAC Program seeks to reduce denials

The Social Security Act requires states to engage one or more recovery audit contractors to identify underpayments and overpayments and recoup overpayments in Medicaid fee for service claims submitted by providers. The OIG's Recovery Audit Contractor (RAC) Program recovered more than $52 million in fiscal year 2022.

Recently, the RAC Program has focused on increasing provider education to decrease technical denials. Some of the initiatives undertaken over the last two years include:

• Increasing communications with providers to ensure RAC record requests and updates are not overlooked.
• Deployment of a simplified provider portal for submitting and tracking document progress.
• Use of electronic attestation for document submission to reduce affidavit issues.
• Meeting with providers with high technical denial rates to discuss the program and the providers’ processes.

As a result of these efforts, the OIG has seen compliance increase by almost 9% since May 2021, with 96% of providers meeting program requirements. The technical denial rate also decreased by 10% over the same period.