Ohio Department of Medicaid – Recovery Audit Contract Issue

The Ohio Department of Medicaid’s contract with their Recovery Audit Contractor (RAC) ended in July 2014. As part of ending that contract, they have made significant progress in the process of reconciling all of the RAC work performed to identify the various scenarios that need to be addressed. Medicaid is still working on the other areas of Ohio Medicaid and Medicaid providers to rectify inappropriate recoupments. Here are a few frequently asked questions regarding the RAC issue as provided by the Ohio Department of Medicaid: 


1. Q:  The RAC vendor recouped entire claims in error or recouped more funds than noted on their notification letter. How do I get these claims corrected?

A:  There is no action required on the part of the provider. The Department is working internally to correct inappropriate recoupments.

2. Q:  The RAC vendor requested medical records and they were submitted; however, we never received a decision on the medical record. How is this being handled?

A:  The Department is not taking action on any medical record reviews that were not completed by the RAC vendor.

3. Q:  How is interest being accrued? Will we be penalized for delays in the process?

A:  Interest will only be accrued for a total of 405 days. The number of days to accrue interest was determined by calculating the shortest time frame that interest would have accrued for any provider that had claims appropriately recouped.

4. Q:  We requested an appeal from the RAC vendor but we never received a response to our request. What happens next?

A:  Outstanding appeals will be handled on a case-by-case basis. 

5. Q: When can we expect the corrections to our payments?

A:  We will be starting the correction to payments in batches. Providers will first be notified by mail with a letter explaining the situation and the letter will be accompanied by the detail behind any refund due to the provider. The actual refund will appear as a lump sum on a future remittance advice.

6. Q: What is the status of procuring a new RAC for Ohio Medicaid?

A: The new RAC RFP went live on May 29, 2015.

Questions not answered above can be directed to 1-866-841-0002, Option 2.

The Pollen Line is now closed. See you in the spring!

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