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Wednesday, September 25, 2013

Get Ready to Say Hello to a New RAC

by James Swann

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Medicare Advantage plans will soon be introduced to their new RAC, a CMS official said at the AHIP Medicare conference I attended this week. Sonja Brown, a CMS health insurance specialist, said the agency expects to award the RAC contract for Medicare Part C by the end of 2013. CMS had originally planned to award the Part C RAC contract this past summer, according to a CMS report from February.

Brown also gave an update on the Part D RAC, ACLR Strategic Business Solutions, of Livonia, Mich., which has completed a review of excluded prescribing providers for plan year 2007. ACLR is currently engaged in a review of excluded providers for plan years 2009 through 2011, and is in the early stages of a review of duplicate Part D payments for the 2009 plan year. The excluded provider reviews were the result of problems with CMS's prohibition against making payments for prescriptions written by excluded providers.

 
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